CMS-10887 Medicare Prescription Payment Plan example data layout

Appendix A – Medicare Prescription Payment Plan example data layout
CMS is providing an example technical layout for the submission of the beneficiary-level data
elements described in this Information Collection Request. CMS will provide a finalized layout as
part of additional technical guidance related to Medicare Prescription Payment Plan reporting to
Part D plans prior to fall 2024.
Table 6: M3P Change Transaction - TC 93

Item
1

Field
Beneficiary Identifier

Size
12

Position
1-12

Description
Required.
Reject the transaction with TRC007 if following
criteria is not met during MBI transition:
1. Format must be one of the following:
• HICN is a 7 to 12 position value, with
the first 1 to 3 positions possible
alphas, and the last 6 or 9 positions
numeric (RRB number).
• HICN is an 11-position value, with the
first 9 positions numeric and the last 2
positions being alpha in the first space
and alpha-numeric or blank in the
second (Non-RRB number).
• MBI is when the 2nd, 5th, 8th and 9th
positions are alphas.
2. String must contain NO embedded spaces.
Reject the transaction with TRC008 if the
beneficiary identifier is not found.

2

Surname

12

13-24

Beneficiary’s last name. Required.

3

First Name

7

25-31

Beneficiary’s first name. Required.

4

M. Initial

1

32

Beneficiary’s middle initial. Optional.
Required.
1 = Male.
2 = Female.
0 = Unknown.

5

Gender Code

1

33

6

Birth Date

8

34-41

7

Filler

1

42

YYYYMMDD. Required.
Space.

Item

Field

Size

Position

Description
Three-character Plan Benefit Package (PBP)
identifier, 001 – 999 (zero padded).
PBP is required for all organizations except
HCPP and CCIP/FFS demos. For these nonPBP organizations, populate with spaces.

8

PBP #

3

43-45

9

Filler

1

46

10

Contract #

5

47-51

11

Filler

8

52-59

Spaces.

12

Transaction Code

2

60- 61

93

13

Filler

2

62- 63

Spaces.

14

M3P Effective Date

8

64-71

15

M3P End Date

8

72-79

16

M3P End Reason Code

1

80

17

Transaction Tracking ID

15

210-224

Optional value created and used by the Plan
to track the replies of the transaction.

18

Filler

76

225- 300

Spaces.

Space.
Contract Number. Required.
Hxxxx = Local Plans.
Rxxxx = Regional Plans.
Sxxxx = PDPs.
Fxxxx = Fallback Plans.
Exxxx = Employer sponsored MA/MAPD
and PDP Plans.

YYYYMMDD. Required.
The effective date for the transaction.
Format (YYYYMMDD)
If the End Date field is non-blank:
Fail with TRC 259 if the date is not a valid
date.
Reject with TRC 260 if the End Date is not
appropriate for one or more of the following
reasons:
It is before the effective date.
, or
It is not within the contract enrollment period.
V = Voluntary
I = Involuntary