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On November 30th, 2023, CMS released the updated Plan Communications User Guide (PCUG) 17.4v for Medicare Advantage and Prescription Drug Plans.

Some of the changes include the following:

Section Change Description
Global
  • Updated the version to 17.4
  • Updated the publish date to November 30, 2023
  • Updated Table of Contents, Layout, Report, Table, Figure, and Section References
1 Introduction

  • No Change
2 Establish Connectivity

  • No Change
3 Eligibility and Enrollment:

  • Added new Special Election Period (SEP) reason codes: 42 & 43. Updated SEP reason codes: 23, 34, 95 & 96. Also updated table heading to reflect MA/MA-PD.
  • Added new Transcript Reply Code (TRC) 403-F.
4 Low Income Subside (LIS) Status:

  • No Change
5 Premium:

  • No Change
6 Payment:

  • No Change
7 Outbound Files and Miscellaneous:

  • No Change
8 MARx UI:

  • No Change
9 Glossary and Acronyms

  • No Change

 

Although the changes are minimal for this version, you may want to ask yourself some valuable questions:

  • Have you reviewed the change impact to your Enrollment and Eligibility transactions to ensure they have been updated accordingly?
    • Transaction Process
    • Daily Transaction Reports
    • Enrollment Disenrollment Transaction Process
    • Cost Plan Transaction Process
    • Full Enrollment File
    • Coordination of Benefits
  • Are all your outbound/inbound file frequency following the MARx 2024 Operational Calendar? The MARx Monthly Calendar for 2024 indicate the following dates:
    • Plan Data Cut-Off
    • Payment to Plan
    • Monthly Reports Available
    • Annual Election Period
    • Certification of Enrollment
    • CMS Holidays (MARx Operational Calendars)
  • Are you using the most up to date file layouts provided in the CMS PCUG in the most efficient and effective way?
  • Do you have the proper audit controls in place for inbound/outbound file processing oversight and error log monitoring?

Did you know transactions also enter the system from other sources, including the 1-800 MEDICARE Service Center? For an overview of the methodologies that CMS employs for transaction processing, see the Medicare Managed Care Eligibility and Enrollment website. In the “Downloads” section, refer to the Enrollment and Disenrollment Guidance documents. Our Garnet Care team also has the expertise to assist you in navigating through this guidance.

Let our Garnet Care team help you ensure your inbound/outbound CMS files and Vendor files are adhering to the latest and greatest PCUG and other CMS sources! We can quickly identify the impact of these to your operational processes and ensure a successful change implementation or help you get started if you are new to Medicare. Garnet Care also understands budget constraints and ongoing challenges, but we do more with less! Our customized approach delivers superior results with expert guidance and support. We would love to hear from you!

Photo of Garnet Care practice lead Courtney Seypura

Courtney Seypura is practice lead for Garnet Care. She has more than 20 years of experience in Medicare and Medicaid operations and project management. Garnet Care helps health plans, administrators, hospitals, and providers improve patient experience and program performance through system and process optimization. Courtney can be reached by email at cseypura@garnetriver.com or by phone 518-605-0216.

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