How To Download Retiree Response Files - Updated 01/31/2008
The following document describes the RDS Secure Web Site process and step-by-step instructions on how to download retiree response files using the RDS Secure Web Site. This download process only applies to those retiree files uploaded via the RDS Secure Web Site, not for those retiree files sent mainframe or VDSA. This document includes information about the following:
- What is a retiree response file?
- What terminology do I need to understand to download retiree response files?
- What if CMS’ RDS Center rejects one of my retirees/beneficiaries and I do not agree with the decision?
- What does it mean if a record in my Response File has a Reason Code of 00?
- What do I do if I do not have any qualifying covered retirees?
- What do I do if I resubmitted a previously rejected retiree and CMS' RDS Center rejects him for a second time?
- How do I access the retiree response file feature in the RDS Secure Web Site?
- How do I download a retiree response file?
- What if the retiree response file I'm looking for is not posted on the RDS Secure Web Site?
- What is the naming convention of the retiree response file?
- How is CMS' RDS Center calculating RDS subsidy periods?
- What data is included in the retiree response file?
- What do I do if a retiree has a reason code 16 – Not a valid Medicare Beneficiary?
- How will I know when the monthly retiree response files are available for download?
- What do I do if I have a question about a specific retiree's response information sent from CMS' RDS Center?
- Why do some of my retirees have a Reason Code 12 and their Subsidy Period Termination Date is the end of the month?
- If I sent a delete transaction what determination indicator and reason code will I receive in my response file?
- What should I do if my retiree's enrollment changes?
What is a retiree response file?
When a Plan Sponsor submits a retiree file for an RDS application, CMS' RDS Center verifies the Medicare entitlement for each retiree by checking the system of record, Medicare Beneficiary Database (MBD), for this information. Based on the information in the MBD, CMS' RDS Center supplies Plan Sponsors response records indicating the period of time during the plan year for which the Plan Sponsor may claim the RDS subsidy for that individual. These response records make up the retiree response file.
What terminology do I need to understand to download retiree response files?
Qualifying Covered Retiree - A Part D eligible individual who is: a participant or the spouse or dependent of a participant; covered under employment-based retiree health coverage that qualifies as a qualified retiree prescription drug plan; and not enrolled in a Part D plan.
Retiree File - The retiree file is a collection of data about the individual for whom you have applied for subsidy. This is a generic term used to describe the valid initial retiree list and monthly add/update/delete retiree files.
- Valid Initial Retiree List - A Retiree Drug Subsidy (RDS) application consists of both a valid initial online application and a valid initial retiree list. In order to submit a timely RDS application for a given plan year, a Plan Sponsor must submit a valid initial online application AND a valid initial retiree list by no later than 90 days prior to the beginning of the plan year, unless a 30-day application deadline extension has been requested and approved by the Centers for Medicare & Medicaid Services (CMS) prior to the expiration of the application deadline. If a 30-day application deadline extension is approved, a Plan Sponsor must submit a valid initial online application AND a valid initial retiree list no later than 30 days after the above-mentioned application deadline. A Plan Sponsor application that fails to meet these requirements is not timely and the Plan Sponsor will receive a notification that its application has been denied.
Initially, each beneficiary (retiree or his/her dependent(s)) should have a detail record or row in this file. If a beneficiary has more than one coverage period or benefit option under your drug plan, you must send a record for each benefit option combination and coverage period. CMS' RDS Center will send the initial retiree response file using the same file format as the valid initial retiree list. - Monthly Add/Update/Delete Retiree Files - You will submit an add/update/delete retiree file on a monthly basis. This file will be in the same format as the valid initial retiree list, but it will only include detail records of individuals for whom you would like to report a change of information. If no information has changed for a given month, you do not need to retransmit an add/update/delete retiree file.
- Retiree Response Files - When a Plan Sponsor submits a valid initial retiree list or monthly add/update/delete retiree file for an RDS application, the RDS Center verifies the Medicare entitlement for each retiree by checking the system of record, Medicare Beneficiary Database (MBD), for this information. Based on the information in the MBD,the RDS Center supplies Plan Sponsors corresponding response records indicating the period of time during the plan year for which the Plan Sponsor may claim the subsidy for that individual. These response records make up the retiree response file.
The retiree response file will contain one record or row for each individual submitted on the valid initial retiree list or the monthly add/update/delete retiree file as applicable. The file will include the same data elements originally submitted, including covered subsidy periods and other RDS data. The retiree response file is always sent from the RDS Center using the same retiree submission method in which it was received from the Plan Sponsor. - Weekly Notification Files – A notification is a message from the RDS Center concerning a qualifying covered retiree, and their Medicare entitlement or RDS coverage. When there is an event that may impact a Plan Sponsor's ability to receive subsidy for a beneficiary, the RDS Center is notified by Medicare. Events that may affect a Plan Sponsor's ability to receive subsidy payments for a beneficiary include, but are not limited to: a change in Medicare entitlement, the death of beneficiary, disenrollment, enrollment or attempted enrollment into a Medicare Part D plan.
The RDS Center will convey notifications and any resulting changes in RDS coverage to Plan Sponsors via weekly notification files. Only the initial Medicare Part D rejection notification will be available to view using the RDS Secure Web Site. - Comma Separated Value (CSV) File - The Comma Separated Value (CSV) file is also referred to as a "flat file" or "comma delimited file." Computer systems use this type of file to pass information back and forth between databases. Each line represents one entry or record and a comma separates each field within a record. In this case, there will be at least one record for each beneficiary you have submitted for subsidy and a comma in-between each of the data elements. If your valid initial retiree list or the monthly add/update/delete retiree file was submitted in CSV format, via the RDS Secure Web Site, the corresponding retiree response file will be returned in the same way. You can import the CSV file using a Windows application, such as Microsoft Excel, for easy viewing.
What if CMS' RDS Center rejects one of my retirees/beneficiaries and I do not agree with the decision?
If CMS' RDS Center rejects one of your retirees, please verify that the retiree's information was entered correctly. If incorrect information was entered, please change the information accordingly and resubmit in the next monthly add/update/delete retiree file. If the retiree was denied for the subsidy all together, resubmit that record as an Add. If there was only a discrepancy in the subsidy periods resubmit the record as an Update.
If after verifying the retiree's information, you believe the determination made by CMS' RDS Center is incorrect, please resubmit the retiree on the next monthly add/update/delete retiree file. The reason for the rejections could be that the retiree's information has been updated at CMS' RDS Center or at MBD, causing the determination to be different then what you were expecting.
What does it mean if a record in my Response File has a Reason Code of 00?
If a record has a Reason Code of 00 and a Determination Indicator of "Y", the row has been accepted by CMS' RDS Center. You will be eligible to receive a subsidy payment for the individual identified in that row.
If a record has a Reason Code of 00 and a Determination Indicator of "N", the subsidy period you requested for the retiree is outside the range of the plan year for the application, or the subsidy end date you requested is before 01/01/2006, the beginning of the RDS Program.
What do I do if I do not have any qualifying covered retirees?
If your retiree response file indicates that you do not have any valid retirees, please verify that the information was entered correctly. If incorrect information was entered, please change the information accordingly and resubmit in the next monthly add/update/delete retiree file. If the retiree was denied for the subsidy all together, resubmit that record as an Add. If there was only a discrepancy in the subsidy periods resubmit the record as an Update.
If after verifying the retiree's information, you believe the determination made by CMS' RDS Center is incorrect, please resubmit the retiree on the next monthly add/update/delete retiree file.
What do I do if I resubmitted a previously rejected retiree and CMS' RDS Center rejects him for a second time?
If after resubmitting a previously rejected retiree CMS' RDS Center issues a second rejection and you still do not feel that the decision is correct, please call the RDS Help Line and report the discrepancy.
How do I access the retiree response file feature in the RDS Secure Web Site?
- After logging onto the RDS Secure Web Site select the Manage Retirees page. You may select one of the following methods for accessing the Manage Retirees page:
- Application List page or Application Status page.
- Application List page - find the appropriate Application Number. Select the Manage Retirees option in the Actions drop down list and click the Go button.
- Application Status page - select the Manage Retirees link.
- Application List page - find the appropriate Application Number. Select the Manage Retirees option in the Actions drop down list and click the Go button.
- Application List page or Application Status page.
- From the Manage Retirees page select the View Medicare Part D Enrollment Rejection Notifications link.
- From the Manage Retirees page select the Download Retiree Response File link.
How do I download a retiree response file?
- From the Download Retiree Response File page locate the file you wish to download and double click on it.
- The File Download window shows the progress of the download.
- You may now download another file or select the Return to Manage Retirees button.
What if the retiree response file I'm looking for is not posted on the RDS Secure Web Site?
If you are expecting a retiree response file and cannot find it on the RDS Secure Web Site, it could be for one of the following reasons:
- If the retiree file was submitted to CMS' RDS Center via Mainframe-to-Mainframe or VDSA you will never see the corresponding response file on the RDS Secure Web Site. Retiree response files will be transmitted back in the same manner that the Plan Sponsor submitted the corresponding retiree file.
- If you have uploaded your valid initial retiree list to the RDS Secure Web Site but have not submitted the application, the retiree file has not yet been processed. Retiree file processing only begins once you submit the application.
- If you have submitted your application, uploaded your valid initial retiree list but you have not received the e-mail indicating final approval, the retiree response file is not available for download. The retiree response file should be available for download within two business days of receiving the final approval. If more than two business days have passed contact the RDS Help Line for more information.
Otherwise, your monthly add/update/delete retiree response file should be posted on the RDS Secure Web Site approximately three to five days after submission. If these timeframes have passed and you do not yet have your retiree response file, contact the RDS Center for more information.
What is the naming convention of the retiree response file?
The response file will have the same name as the retiree file to which it corresponds with the prefix of "Resp_". For example, if the file you uploaded was named 2006RetireeList.csv the response file will be named Resp_2006RetireeList.csv.
How is CMS' RDS Center calculating RDS subsidy periods?
To process a retiree file, RDS will query the Medicare Beneficiary Database (MBD) and determine if each individual is a Qualifying Covered Retiree, eligible for the subsidy based on Medicare entitlement. RDS will then determine the periods of time the retiree can be claimed for the subsidy during the plan year. Subsidy periods will be sent back in the retiree response file (see record layout below).
What data is included in the retiree response file?
The retiree response records will contain all the original fields sent by the Plan Sponsor, plus the determination indicator, subsidy dates, and reason code. Refer to How to Upload a File for detailed information about the Retiree Record Layout. The Plan Sponsor may receive multiple responses (records) for a single beneficiary in the event that there is a gap in RDS Coverage Periods based on Medicare entitlement.
Note: Retiree response files must be processed by Plan Sponsors and subsidy periods posted in their internal systems so that the appropriate payment calculations may be performed.
Retiree Responses from CMS' RDS Center to Plan Sponsors - Download file via the RDS Secure Web Site
| Data element | Max size | Notes |
|---|---|---|
| Determination Indicator | 01 | Y = Yes, the retiree qualifies for the RDS subsidy. N = No, the retiree does not qualify for the RDS subsidy. |
| Reason Code | 02 | See Reason Code list provided. |
| Subsidy Period Effective date | 08 | CCYYMMDD. The effective date of the beneficiary's RDS coverage. See Reason Code list for how these dates are filled in combination with specific scenarios. |
| Subsidy Period Termination date | 08 | CCYYMMDD. The termination date of the beneficiary's RDS coverage. See Reason Code list for how these dates are filled in combination with specific scenarios. |
What do I do if a retiree has a reason code 16 – Not a valid Medicare Beneficiary?
If a retiree has a reason code 16 – not a valid Medicare Beneficiary, you must research the data elements submitted to the RDS Center for that individual retiree. Please research the data elements provided in the retiree file, such as date of birth, gender, and SSN or HICN, to ensure the information provided is accurate. If any data element is entered incorrectly, please correct and resubmit the retiree data in your next monthly add/update/delete retiree file. In the case of a subsidy period request for a retiree's dependent or spouse the SSN should correspond with the individual for whom you are requesting a subsidy period, such as that of the dependent or spouse, not the retiree.
How will I know when the monthly retiree response files are available for download?
The Account Manager and Designee, with file submission privileges, will receive an e-mail indicating that monthly retiree response files are available for download. This e-mail notification process is effective 12/15/2005. Any response file delivered by CMS' RDS Center prior to 12/15/2005 will not have an associated e-mail.
What do I do if I have a question about a specific retiree's response information sent from CMS' RDS Center?
If you have a question about the retiree response information returned from CMS' RDS Center, and you believe the information you submitted is correct, please resend the information in your next monthly add/update/delete retiree file. If the retiree was originally denied the subsidy, send the retiree file as an "add". If the retiree was accepted for the subsidy, but not for the date ranges you originally intended, send the retiree file as an update.
If after the second submission you still have a question, please call the RDS Help Line for assistance.
Why do some of my retirees have a Reason Code 12 and their Subsidy Period Termination Date is the end of the month?
If some of your qualifying covered retirees have been assigned a future date of death, this is not an error. In situations where the Social Security Administration (SSA) was notified of the qualifying covered retiree’s death, but did not receive official confirmation (i.e. a copy of the death certificate), then it will automatically report a default date of death, which is the last day of the month. When SSA receives official confirmation of the qualifying covered retiree’s date of death, it will update the Medicare Beneficiary Database (MBD) with the actual date of death. This date will replace the future date of death (the last day of the month), which previously had been reported. At this time, MBD will notify the RDS Center with the official date of death. The RDS Center will send a notification with the qualifying covered retiree’s official date of death as the subsidy termination date in your next weekly notification file. We recommend that you process each notification as you receive it so that your records reflect the current subsidy periods in the RDS system.
If I sent a delete transaction what determination indicator and reason code will I receive in my response file?
If you sent a delete transaction in your last monthly add/update/delete retiree file, requesting the RDS Center to delete a record, and the RDS Center accepted the transaction you will receive a determination indicator of "Y." The "Y" indicates the delete was successful and the subsidy dates match the Plan Sponsor's coverage dates. If the RDS Center rejected the delete transaction you will receive a determination indicator of "N" and reason code 17 - no coverage period exists for delete transaction. This means that either no match was found in the RDS database for the deleted transaction or there was an error in the record, and the RDS Center has made no update.
What should I do if my retiree's enrollment changes?
Plan Sponsors should utilize the monthly add/update/delete retiree file to add, update, or delete subsidy periods as applicable. If the Plan Sponsor believes the beneficiary is now eligible for the subsidy, send an add record to the RDS Center with the subsidy period requested. If the Plan Sponsor believes the beneficiary coverage has changed from what was previously reported, send an update record to the RDS Center with the subsidy period requested. If the beneficiary is no longer eligible for the subsidy, send a delete record to the RDS Center. The delete record coverage dates should match those you previously submitted. This rule also applies if you want to move a beneficiary from one benefit option to another, effectively replacing the previous coverage.
