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MAPD Plan Communications User Guide (PCUG)

The MAPD Plan Communications User Guide (PCUG) contains information regarding the use of the Medicare Advantage Prescription Drug (MARx) System, an overview of how Plans will send data to CMS, and descriptions of the specific data files and reports that are exchanged between the Plans and CMS. The PCUG Main Guide, Appendices, and Transmissions Inventory documents are located in the “Downloads” section.

Sample sections from the PCUG Main Guide include:

• Establishing Communications
• Accessing systems for Eligibility Verification
• Processing Transactions
• Understanding the Payment Process and Calculations
• Understanding Premium Withhold Options
• Understanding Coordination of Benefits
• Reporting 4Rx Data Elements
• Establishing Low Income Subsidy Status
• Using the MARx System
• Reporting Identified Drug Overutilizers

Sample sections from the PCUG Appendices include:

• Glossary and Terms
• Data File Record Layouts
• Transaction Codes and Transaction Reply Codes
• Report Files
• Plan Connectivity Checklist

Transmissions Inventory

• Overview of Transmissions To and From CMS
• Dataset Names
• Transmission Frequency

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