How To Download Covered Retiree List - Updated 11/16/2007
The following document contains information regarding how to download covered retiree lists. Instructions about who may download them, when they can be downloaded and other information are documented here. This document includes information about the following:
- What is the purpose of downloading the covered retiree list?
- When can the covered retiree list be downloaded?
- Who can download the covered retiree list?
- How can the Plan Sponsor tell if the covered retiree list is available?
- What if the covered retiree list is not posted on the RDS Secure Web Site?
- What if there are no valid retirees?
- What is the naming convention of the covered retiree list?
- What is the format of the covered retiree list?
- What is included in the covered retiree list?
- What if I do not agree with the covered retiree list?
- Will all of the retirees I have submitted be included in the covered retiree list?
- How does a Plan Sponsor download a covered retiree list?
What is the purpose of downloading the covered retiree list?
The purpose of downloading the covered retiree list is for comparison against the Plan Sponsor's internal records with those of CMS' RDS Center. Plan Sponsors should download and review the covered retiree list on a regular basis to make sure that the beneficiaries, benefit options, and subsidy periods correspond to the Plan Sponsor's internal records. During reconciliation, the Plan Sponsor is required to review and agree to the covered retiree list. Plan Sponsors may only submit costs for the beneficiaries, benefit options, and subsidy periods listed in the covered retiree list that is downloaded from CMS' RDS Center.
When can the covered retiree list be downloaded?
The covered retiree list should be available within two business days from the time of the request.
Who can download the covered retiree list?
The covered retiree list can be downloaded by the Authorized Representative and the Account Manager. Designees with the Retiree Data privilege may access the Download Covered Retiree List page using the Manage Retirees page. Designees must have both the Retiree Data privilege and the Request Payment privilege to access the Download Covered Retiree List page using the direct link from Step 3 and Step 4 of the Reconciliation Checklist.
How can the Plan Sponsor tell if the covered retiree list is available?
The Plan Sponsor should monitor the Download Covered Retiree List page to determine if a list is available for download. The covered retiree list should be available within two business days from the time of the request. For more information about downloading the covered retiree list, go to: How does a Plan Sponsor download a covered retiree list?
What if the covered retiree list is not posted on the RDS Secure Web Site?
If a covered retiree list is expected but not received, then the request may still be processing at CMS' RDS Center. The covered retiree list should be available for download within two business days after the request for the list is made. If more than two business days have passed, the Plan Sponsor should check the retiree counts for the application to verify that they are not equal to zero. For more information about viewing retiree counts, go to: How To View Retiree Counts. If retiree counts are greater than zero for this application and a file has not been received after 4 business days, contact the RDS Help Line for more information.
What if there are no valid retirees?
If a covered retiree list was not received because there are zero valid retirees, please verify that the information in the last submitted retiree list was entered correctly. If incorrect information was entered, change the information accordingly and resubmit in the next ADD/UPD/DEL retiree file. If the response file indicates that no subsidy periods have been approved for the beneficiaries on this application, please contact the RDS Help Line for more information.
What is the naming convention of the covered retiree list?
The name of the covered retiree list includes the Plan Sponsor ID, Application ID, and the date the list was created. This identifying information will have the prefix "Covered_". For example: Plan Sponsor 999 with application ID 888 that had a file delivered on April 2, 2007 would have a file named "Covered_0000000999_0000000888_20070402".
What is the format of the covered retiree list?
The covered retiree list will be in Comma Separated Value (CSV) format. The 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 data element within a record. A separate record is created for each unique beneficiary, benefit option and subsidy period combination. Each record will include the following data elements:
| Data element | Max size | Notes |
|---|---|---|
| Application ID | 10 | RDS application number under which the retiree was approved for subsidy. |
| SSN* | 09 | Social Security Number for the beneficiary that was approved for RDS. This field may be blank if the HICN was provided instead during retiree list submission. |
| HICN* | 12 | Medicare Health Insurance Claim Number for the beneficiary that was approved for RDS. This field may contain spaces if the SSN was provided instead during retiree list submission. |
| First name* | 30 | Beneficiary's First Name. |
| Middle initial* | 01 | Optional field. Beneficiary's Middle Initial. |
| Last name* | 40 | Beneficiary's Last Name. |
| Date of birth* | 08 | CCYYMMDD. |
| Gender* | 01 | 0=gender unknown, 1=male, 2=female. |
| Effective date* | 08 | CCYYMMDD.The beginning date the beneficiary's (retiree, spouse, or dependent) coverage under this prescription drug benefit option. |
| Termination date* | 08 | CCYYMMDD.The ending date the beneficiary's (retiree, spouse, or dependent) coverage under this prescription drug benefit option. |
| Unique Benefit Option Identifier (UBOI) | 20 | The unique identifier assigned to this prescription drug benefit option. |
| Relationship to retiree* | 02 | 01=self, 02=spouse, or 03=other |
| Type of Record* | 03 | ADD or UPD. Will be equal to the last record type submitted for this beneficiary in a retiree file. |
| Determination Indicator | 01 | Y = Yes. All records in the Covered Retiree File are approved for subsidy. |
| Reason code | 02 | See Reason Code List Below. |
| Subsidy Period Effective Date | 08 | CCYYMMDD. The effective date of the beneficiary's (retiree, spouse, or dependent) RDS coverage. |
| Subsidy Period Termination Date | 08 | CCYYMMDD. The termination date of the beneficiary's (retiree, spouse, or dependent) RDS coverage. |
| Submitter Type | 01 | P=Plan Sponsor, V=Vendor, C=VDSA/COB |
| Submitter Name | 50 | Plan Sponsor, Vendor, or COB Contractor name |
Note: All of the data elements noted with an asterisk (*) will contain the latest information provided by the Plan Sponsor in a retiree list.
| Code | Description |
|---|---|
| 10 | Enrolled in Medicare Part D - Beneficiary is enrolled in Medicare Part D for some portion of the period of RDS coverage for which you previously applied. If this eligibility creates a gap in the coverage period you will receive more than one record for this beneficiary. Refer to the Subsidy Period Effective date and Subsidy Period Termination Date for the period that you may claim the beneficiary for the subsidy. Disclaimer: Due to the sensitive nature of this information, CMS' RDS Center is not at liberty to discuss specific entitlements with Plan Sponsors. |
| 11 | Not eligible for Medicare - The Beneficiary does not have Medicare Part A or B Coverage for some portion the period of RDS coverage for which you previously applied. If this eligibility creates a gap in the coverage period you will receive more than one record for this beneficiary. Refer to the Subsidy Period Effective date and Subsidy Period Termination Date for the period that you may claim the beneficiary for the subsidy. Disclaimer: Due to the sensitive nature of this information, CMS' RDS Center is not at liberty to discuss specific entitlements with Plan Sponsors. |
| 12 | Beneficiary is deceased – The beneficiary's date of death falls within the period of RDS coverage for which you previously applied. The beneficiary's death has been reported to CMS' RDS Center by MBD. Refer to the Subsidy Period Effective date and Subsidy Period Termination Date for the period that you may claim the beneficiary for the subsidy. Disclaimer: Due to the sensitive nature of this information, CMS' RDS Center is not at liberty to discuss specific entitlements with Plan Sponsors. |
What is included in the covered retiree list?
This list includes the same fields currently required in RDS covered retiree reporting plus two additional fields that will give reporting source information for the convenience of the Plan Sponsor. The covered retiree list includes all beneficiaries having at least one benefit option where at least one subsidy period exists. A separate record is created for each unique beneficiary, benefit option and subsidy period combination. Any retiree records that were submitted to and rejected by CMS' RDS Center will not be reflected in this list. For a list of data elements, go to: What is the format of the covered retiree list?
What if I do not agree with the covered retiree list?
If a retiree record that was expected to be on this list is absent, or if any of the subsidy periods do not match the Plan Sponsor's internal records, the Plan Sponsor should begin by ensuring that they have processed all of the retiree response and weekly notification files for this application. After all files have been processed the Plan Sponsor should compare their updated internal records to the covered retiree list.
Submit an ADD/UPD/DEL retiree file containing records for the beneficiaries in question when the following occurs:
- The Plan Sponsor's internal records still indicate that the beneficiaries not appearing on the covered retiree list have approved subsidy periods under this application.
- The Plan Sponsor's internal records still indicate that the beneficiaries have different approved subsidy periods under this application.
- The Plan Sponsor is unable to process the retiree response and weekly notification files for any reason.
OR
OR
If the above actions do not resolve the discrepancies the Plan Sponsor should work with the beneficiary to validate all identifying information (e.g. Date of Birth, HICN, or SSN) and Medicare coverage. The beneficiary may contact 1-800-Medicare to discuss any identifying information or coverage issues. If the Plan Sponsor is still unable to resolve the discrepancy, contact the RDS Help Line for assistance.
To learn more about working with retiree files and notification files go to: How To Manage Retirees.
Will all of the retirees I have submitted be included in the covered retiree list?
No. Any retiree records that were submitted to and rejected by CMS' RDS Center will not be reflected in this list.
How does a Plan Sponsor download a covered retiree list?
- Log into the RDS Secure Web Site.
- The Plan Sponsor List With Application Summary page displays.
- Select the appropriate Plan Sponsor ID link. The Application List page displays.
- From the Application List page, find the Application Number for which the covered retiree list should be downloaded. Select Manage Retirees from the Actions dropdown and select Go.
- From the Manage Retirees page select the Download Covered Retiree List link to see the list of Covered Retiree Lists for this application that are available for download.
Note: E-PHI Agreement will appear. Select I Accept to proceed to the Download Covered Retiree List page. Select Cancel to return to the Manage Retirees page.
- From the Download Covered Retiree List page locate the file to download and double click.
- The File Download window shows the progress of the download.
- Another file may be downloaded or select Return to Manage Retirees.
