Common use of Coverage Type Clause in Contracts

Coverage Type. The coverage type codes used on the non-MSP file will be consistent with those used on the MSP file, but not all MSP file coverage types will be relevant. CMS needs supplemental drug coverage on the non-MSP file. If the partner is describing a network (EDI) pharmacy benefit, the coverage type will be U, W, X, or Y. If the partner is describing a non-network pharmacy benefit the coverage type will be V, Z, 4, 5, or 6. Insurer Name- This is the name of the private insurer providing prescription drug coverage. CMS asks for this to facilitate proper billing at point of sale. The ‘D’ record in the Non-MSP Response File will also contain whatever information was provided in the incoming file, i.e. SSN or Medicare ID (HICN or MBI), DOB, Rx ID, etc. The Non-MSP Response File will also contain the Rx Disposition Code and Rx Error Codes that will be contained in the MSP Response record for the same reasons and according to the same rules as described in the MSP File section above. Special Note about the “ID” Disposition Code Partners may see the term “ID” as a value in the Rx Disposition Code field in the D/N Disposition Code field on their Non-MSP Response Files (Field 48). This “ID” Disposition Code is being caused by an identification error at the CMS Medicare Beneficiary Database (the MBD). Response records you get that have an “ID” code in an Rx Disposition Code field are those that have not yet been accepted by the MBD. However, these response records returned to you do include whatever Medicare information the BCRC had received, if any, from the MBD and stored for that beneficiary in the BCRC’s own database. But without a confirmation of acceptance of a record from the MBD, the record’s data can not be considered validated. To confirm acceptance of such records Partners should include them as part of their next quarterly submission. ‘N’ – Non-Reporting Query Record and Response Non-MSP Input Files with an ‘N’ Action Type (that is, a “query only” filing) will require the following minimum data set: Medicare ID (HICN or MBI) or SSN, last name, first initial, date of birth, and sex. All are included as part of the current Non-MSP Input File. In response, CMS will provide the Medicare Part A and B entitlement information it now provides in other non-MSP responses, as well as the new Medicare Part D entitlement information, which is described above in the Non-MSP Response File layout. Note that an ‘N’ Action Type (a “query only” input file) includes and is related to information about drug coverage benefits. If a partner wishes to submit a “query only” file not accompanied by information about drug coverage, the file type to use is the Query Only HEW Input File (see A, 2 above).

Coverage Type. The coverage type codes used on the non-MSP file will be consistent with those used on the MSP file, but not all MSP file coverage types will be relevant. CMS needs supplemental drug coverage on the non-MSP file. If the partner is describing a network (EDI) pharmacy benefit, the coverage type will be U, W, X, or Y. If the partner is describing a non-network pharmacy benefit the coverage type will be V, Z, 4, 5, or 6. Insurer Name- This is the name of the private insurer providing prescription drug coverage. CMS asks for this to facilitate proper billing at point of sale. The ‘D’ record in the Non-MSP Response File will also contain whatever information was provided in the incoming file, i.e. SSN or Medicare ID (HICN or MBI), DOB, Rx ID, etc. The Non-MSP Response File will also contain the Rx Disposition Code and Rx Error Codes that will be contained in the MSP Response record for the same reasons and according to the same rules as described in the MSP File section above. Special Note about the “ID” Disposition Code Partners may see the term “ID” as a value in the Rx Disposition Code field in the D/N Disposition Code field on their Non-MSP Response Files (Field 48). This “ID” Disposition Code is being caused by an identification error at the CMS Medicare Beneficiary Database (the MBD). Response records you get that have an “ID” code in an Rx Disposition Code field are those that have not yet been accepted by the MBD. However, these response records returned to you do include whatever Medicare information the BCRC had received, if any, from the MBD and stored for that beneficiary in the BCRC’s own database. But without a confirmation of acceptance of a record from the MBD, the record’s data can not be considered validated. To confirm acceptance of such records Partners should include them as part of their next quarterly submission. ‘N’ – Non-Reporting Query Record and Response Non-MSP Input Files with an ‘N’ Action Type (that is, a “query only” filing) will require the following minimum data set: Medicare ID (HICN or MBI) or SSN, last name, first initial, date of birth, and sex. All are included as part of the current Non-MSP Input File. In response, CMS will provide the Medicare Part A and B entitlement information it now provides in other non-MSP responses, as well as the new Medicare Part D entitlement information, which is described above in the Non-MSP Response File layout. Note that an ‘N’ Action Type (a “query only” input file) includes and is related to information about drug coverage benefits. If a partner wishes to submit a “query only” file not accompanied by information about drug coverage, the file type to use is the Query Only HEW Input File (see A, 2 above).

Coverage Type. The coverage type codes used on the non-MSP file will be consistent with those used on the MSP file, but not all MSP file coverage types will be relevant. CMS needs supplemental drug coverage on the non-MSP file. If the partner is describing a network (EDI) pharmacy benefit, the coverage type will be U, W, X, or Y. If the partner is describing a non-network pharmacy benefit the coverage type will be V, Z, 4, 5, or 6. Insurer Name- This is the name of the private insurer providing prescription drug coverage. CMS asks for this to facilitate proper billing at point of sale. The ‘D’ record in the Non-MSP Response File will also contain whatever information was provided in the incoming file, i.e. SSN or Medicare ID (HICN or MBI)HICN, DOB, Rx ID, etc. The Non-MSP Response File will also contain the Rx Disposition Code and Rx Error Codes that will be contained in the MSP Response record for the same reasons and according to the same rules as described in the MSP File section above. Special Note about the “ID” Disposition Code Partners may see the term “ID” as a value in the Rx Disposition Code field in the D/N Disposition Code field on their Non-MSP Response Files (Field 48). This “ID” Disposition Code is being caused by an identification error at the CMS Medicare Beneficiary Database (the MBD). Response records you get that have an “ID” code in an Rx Disposition Code field are those that have not yet been accepted by the MBD. However, these response records returned to you do include whatever Medicare information the BCRC had received, if any, from the MBD and stored for that beneficiary in the BCRC’s own database. But without a confirmation of acceptance of a record from the MBD, the record’s data can not be considered validated. To confirm acceptance of such records Partners should include them as part of their next quarterly submission. ‘N’ – Non-Reporting Query Record and Response Non-MSP Input Files with an ‘N’ Action Type (that is, a “query only” filing) will require the following minimum data set: Medicare ID HIC Number (HICN or MBIHICN) or SSN, last name, first initial, date of birth, and sex. All are included as part of the current Non-MSP Input File. In response, CMS will provide the Medicare Part A and B entitlement information it now provides in other non-MSP responses, as well as the new Medicare Part D entitlement information, which is described above in the Non-MSP Response File layout. Note that an ‘N’ Action Type (a “query only” input file) includes and is related to information about drug coverage benefits. If a partner wishes to submit a “query only” file not accompanied by information about drug coverage, the file type to use is the Query Only HEW Input File (see A, 2 above).