How To Complete Step 4: Finalize Covered Retirees - Updated 05/29/2009
This document includes information about the following:
- What is the purpose of Step 4: Finalize Covered Retirees?
- When can Plan Sponsors begin Step 4: Finalize Covered Retirees?
- Who is allowed to complete Step 4: Finalize Covered Retirees?
- When can Step 4: Finalize Covered Retirees be completed?
- Who can download the Covered Retiree List?
- How can I tell if Step 4: Finalize Covered Retirees has been completed?
- What happens after Step 4: Finalize Covered Retirees is completed?
- Can Step 4: Finalize Covered Retirees be undone after it is completed?
- Who can request that Step 3: Request List of Covered Retirees and Step 4: Finalize Covered Retirees be changed to an "Incomplete" status?
- What happens after I request that Step 3: Request List of Covered Retirees and Step 4: Finalize Covered Retirees be changed to an "Incomplete" status?
- What do I do after Step 3: Request List of Covered Retirees and Step 4: Finalize Covered Retirees have been changed to an "Incomplete" status?
- Must the Covered Retiree List be reviewed?
- From where can the Covered Retiree List be downloaded?
- What is the format of the Covered Retiree List?
- What is included in the Covered Retiree List?
- When can the Covered Retiree List be downloaded?
- Who should validate the Covered Retiree List?
- What if I do not agree with the Covered Retiree List?
- Why is it important for the Covered Retiree List to be correct?
- Can retirees or subsidy date ranges not on the Covered Retiree List be submitted for subsidy payment?
- Do I reconcile against the Covered Retiree List I am agreeing to?
- Can a Covered Retiree List be requested more than once?
- How does a Plan Sponsor complete Step 4: Finalize Covered Retirees?
What is the purpose of Step 4: Finalize Covered Retirees?
The purpose of this step is for the Plan Sponsor to agree to the Covered Retiree List provided by CMS' RDS Center. The Covered Retiree List includes all of the Qualifying Covered Retirees, corresponding Subsidy Periods, and the Benefit Option(s) in which each Qualifying Covered Retiree is enrolled. The Plan Sponsor will be able to view annual and monthly unique retiree counts that match the Subsidy Periods provided in the Covered Retiree List.
When can Plan Sponsors begin Step 4: Finalize Covered Retirees?
Step 4 cannot be started until Step 1 through Step 3 have been completed and at least one business day has passed since the Plan Sponsor's request for the Covered Retiree List. Step 4 must be marked "Complete" on the Reconciliation Checklist to proceed to the remaining steps.
Who is allowed to complete Step 4: Finalize Covered Retirees?
Step 4 can only be completed by the Authorized Representative or the Account Manager. Designees with the Request Payment privilege will have View Only access to this step.
When can Step 4: Finalize Covered Retirees be completed?
Step 4 can only be completed when:
- Step 1 through Step 3 have been completed
- The last Covered Retiree List was requested after the last Retiree Response File and last Weekly Notification File
- The Covered Retiree List was created after the last Covered Retiree List request
- The last created Covered Retiree List was downloaded
- The Plan Sponsor agrees with the last downloaded Covered Retiree List
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 View/Send/Receive Retiree Data privilege may access the Download Covered Retiree List page using the Manage Retirees page. Designees must have both the View/Send/Receive 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 I tell if Step 4: Finalize Covered Retirees has been completed?
The Reconciliation Checklist displays as follows:
- Step 4 is marked with a green check to indicate that the step is complete and Step 5 is marked with a blue arrow to indicate that it is the next step.
- The status of Step 4 will be marked "Complete" on the Reconciliation Checklist.
- The Last Updated Date and Last Updated By fields are updated accordingly.
- The status of the Application will remain "Reconciliation Initiated."
What happens after Step 4: Finalize Covered Retirees is completed?
When Reconciliation Step 4: Finalized Covered Retirees is complete, the following will occur for this Application:
- The Plan Sponsor will be unable to upload retiree files through the RDS Secure Website.
- Any retiree list submitted through the Mainframe or Voluntary Data Sharing Agreement (VDSA) will not be processed by CMS' RDS Center. Retiree Response Files will no longer be sent. An email will be sent to the Account Manager and Designees with View/Send/Receive Retiree Data privilege notifying them that the submitted retiree list has been rejected.
- CMS' RDS Center will no longer create or send Weekly Notification Files.
- Part D Enrollment Rejection Notifications will no longer be posted to the RDS Secure Website.
- An email will be sent to the Account Manager, Authorized Representative, and Designees with View/Send/Receive Retiree Data privilege informing them that retiree processing has stopped.
The status of the Application will remain "Reconciliation Initiated." The retiree count used to validate cost data for this Application is based on the most recent Covered Retiree List. Note: The most recent Covered Retiree List can continue to be downloaded after Step 4 is "Complete."
Can Step 4: Finalize Covered Retirees be undone after it is completed?
Yes. Plan Sponsors must ensure that the retiree data reflected in the most recent Covered Retiree List is accurate.
Despite a Plan Sponsor's best efforts to ensure that the retiree data reflected in the Covered Retiree List is accurate, there may be instances where a Plan Sponsor becomes aware of changes to its Qualifying Covered Retirees after it has completed Step 3 and Step 4, but before it has completed Step 12: Review and Submit Reconciliation Payment Request. Such changes may include additions or deletions of Qualifying Covered Retirees, changes to the approved Subsidy Periods, and/or changes in which Benefit Option a Qualifying Covered Retiree is enrolled. In such cases, the Plan Sponsor must contact CMS' RDS Center Help Line prior to the completion of Step 12, to request that Step 3 and Step 4 be changed to an "Incomplete" status. When Step 3 and Step 4 are changed to an "Incomplete" status after they have been completed, ALL other Reconciliation steps that have already been completed, beginning with Step 3, will be changed to an "Incomplete" status and must be completed again. However, the Application's Reconciliation Deadline will not change. Please be aware that it will take CMS' RDS Center up to 5 business days to change Step 3 and Step 4 from "Complete" to "Incomplete" status.
Who can request that Step 3: Request List of Covered Retirees and Step 4: Finalize Covered Retirees be changed to an "Incomplete" status?
A request that Step 3 and Step 4 be changed to an "Incomplete" status can only be made by the Authorized Representative or the Account Manager.
What happens after I request that Step 3: Request List of Covered Retirees and Step 4: Finalize Covered Retirees be changed to an "Incomplete" status?
While the request is being processed, the following system conditions are applied to the Application:
- An email acknowledging the request is sent to the Authorized Representative, Account Manager, and Designees with Request Payment privilege.
- The Reconciliation Checklist will be View Only until Step 3 and Step 4 have been changed to an "Incomplete" status.
- Mainframe Final Cost Reports sent during this time will not be accepted until Step 5 is once again completed.
- The Final Costs action will be View Only for data entry cost reporters until Step 5 is once again completed.
- The Application status will change to "Reconciliation Step Status Changing".
After the request is processed, the Plan Sponsor should be aware of the following:
- An email confirming the changes in the step status is sent to the Authorized Representative, Account Manager, and Designees with Request Payment privilege.
- ALL Reconciliation steps that have already been completed, beginning with Step 3, will be changed to an "Incomplete" status and must be completed again in such instances.
- The status of Final Cost Reports that were submitted using the data entry method is set to "Data Entry: Update/Entry Required." For more information about how to work with Cost Reports in this status, go to: How To Complete Step 6: Manage Submission Of Final Cost Reports.
- Mainframe Final Cost Reports are rejected until the status of Step 5 is "Complete" on the Reconciliation Checklist.
- The Application status is changed to "Reconciliation Initiated".
- The Plan Sponsor will again be able to upload retiree files through the RDS Secure Website.
- Any retiree list submitted through the Mainframe or Voluntary Data Sharing Agreement (VDSA) will be processed by CMS' RDS Center.
- Retiree Response Files will be sent.
- Weekly Notification Files will be sent.
- Part D Enrollment Rejection Notifications will again be posted to the RDS Secure Website.
- The Plan Sponsor will again be able to request a Covered Retiree List.
What do I do after Step 3: Request List of Covered Retirees and Step 4: Finalize Covered Retirees have been changed to an "Incomplete" status?
After Step 3 and Step 4 have been changed to an "Incomplete" status, the Authorized Representative, Account Manager, or the Designees with the Request Payment privilege may proceed to complete ALL of the remaining Reconciliation steps marked "Incomplete".
Be aware that a change, such as a change in the Subsidy Periods associated with a Qualifying Covered Retiree, will be reflected in the next Covered Retiree List requested by the Plan Sponsor. Any change in the Covered Retiree List may subsequently require changes to final cost data. Final cost data is aggregated data based on detail drug claims; therefore, even minor changes in the Covered Retiree List require that a Plan Sponsor revisit the Final Cost Reports for the impacted Benefit Options. Note: It is expected that the Plan Sponsor will have internal supporting drug cost details and summarized data that validates all final cost data being reported. Furthermore, it is expected that the Plan Sponsor will compare the summarized data with the Final Cost Reports that have been submitted to ensure that the final cost data that could be included in the Reconciliation Payment Request is accurate.
The following information should be considered when Step 3 through Step 6 are completed again:
- Send Add/Update/Delete Retiree Files that include detail records of Qualifying Covered Retirees for whom you would like to report a change of information.
- Request a Covered Retiree List as discussed in Reconciliation Step 3: Request List Of Covered Retirees.
- The Covered Retiree List should be reviewed and validated by the appropriate persons because final cost data may only be submitted for the Qualifying Covered Retirees, corresponding Subsidy Periods, and the Benefit Option(s) in which each Qualifying Covered Retiree is enrolled, as listed in the Covered Retiree List.
- Sending Add/Update/Delete Retiree Files and requesting Covered Retiree Lists is a process that can happen as many times as necessary until the Covered Retiree List has accurate Qualifying Covered Retirees, corresponding Subsidy Periods, and Benefit Option(s) in which each Qualifying Covered Retiree is enrolled.
- Step 4 can be completed when the retiree counts have been validated and approved, and the Plan Sponsor agrees to the Qualifying Covered Retirees, corresponding Subsidy Periods, and the Benefit Option(s) in which each Qualifying Covered Retiree is enrolled, as listed in the Covered Retiree List.
- When Step 4 is complete, contact your cost reporters, and inform them of the new Covered Retiree List. The cost reporters will need to recalculate final cost data based on the new Covered Retiree List.
- Reconciliation Step 5: Start Preparation Of Reconciliation Payment Request must be completed again to allow final cost reporting.
- Final Cost Reports should be reviewed to ensure that cost reporting is complete and accurate as described in Reconciliation Step 6: Manage Submission Of Final Cost Reports.
- Previously submitted Cost Reports should be re-evaluated if the Qualifying Covered Retirees, corresponding Subsidy Periods, and the Benefit Option(s) in which each Qualifying Covered Retiree is enrolled have changed.
- If Final Cost Reports were previously submitted using the data entry method, final cost data for all plan months must be re-saved and the Final Cost Report must be re-submitted to complete Step 6.
- If Final Cost Reports were previously submitted using the mainframe method, recalculated final cost data should be submitted. Note: If multiple files are sent, the most recent error-free cost report will be used to reflect cost figures for all months in the RDS Secure Website.
- The Plan Sponsor may complete the remaining steps in the Reconciliation Checklist. For more information about completing the remaining Reconciliation steps, go to: Reconciliation How To List.
If you have trouble proceeding with Reconciliation after Step 3 and Step 4 have been changed to an "Incomplete" status, please contact CMS' RDS Center Help Line.
Must the Covered Retiree List be reviewed?
Yes. The Plan Sponsor is REQUIRED to review this list and may only submit final cost data for the Qualifying Covered Retirees, corresponding Subsidy Periods, and the Benefit Option(s) in which each Qualifying Covered Retiree is enrolled, as listed in the most recent Covered Retiree List.
From where can the Covered Retiree List be downloaded?
The Covered Retiree List may be downloaded from the Download Covered Retiree List page, which may be accessed from the Manage Retirees page on the RDS Secure Website. The Download Covered Retiree List page may also be accessed using a direct link from Step 3 or Step 4. For more information about how to download the Covered Retiree List, go to: Request and Download Covered Retiree Lists section of Chapter 10 in the RDS User Guide.
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 Qualifying Covered Retiree, corresponding Subsidy Period(s), and the Benefit Option(s) in which each Qualifying Covered Retiree is enrolled. Each record will include the following data elements:
| Data element | Max size | Notes |
|---|---|---|
| Application ID | 10 | RDS Application number under which the Qualifying Covered Retiree was approved for subsidy. |
| SSN* | 09 | Social Security Number for the Qualifying Covered Retiree 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 Qualifying Covered Retiree that was approved for RDS. This field may contain spaces if the SSN was provided instead during retiree list submission. |
| First Name* | 30 | Qualifying Covered Retiree's First Name. |
| Middle Initial | 01 | Optional field. Qualifying Covered Retiree's Middle Initial. |
| Last Name* | 40 | Qualifying Covered Retiree's Last Name. |
| Date of Birth* | 08 | CCYYMMDD. |
| Gender* | 01 | 0=Gender unknown, 1=Male, 2=Female. |
| Effective Date* | 08 | CCYYMMDD. The beginning date of the Qualifying Covered Retiree's (retiree, spouse, or dependent) coverage under this prescription drug Benefit Option. |
| Termination Date* | 08 | CCYYMMDD. The ending date of the Qualifying Covered Retiree'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 Qualifying Covered Retiree in a retiree file. |
| Determination Indicator | 01 | Y = Yes. All records in the Covered Retiree File are approved for subsidy. |
| Reason Code | 02 | Go to the Covered Retiree List Reason Codes List. |
| Subsidy Period Effective Date | 08 | CCYYMMDD. The effective date of the Qualifying Covered Retiree's (retiree, spouse, or dependent) RDS coverage. |
| Subsidy Period Termination Date | 08 | CCYYMMDD. The termination date of the Qualifying Covered Retiree'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.
What is included in the Covered Retiree List?
The Covered Retiree 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 Qualifying Covered Retirees where at least one Subsidy Period exists. A separate record is created for each unique Qualifying Covered Retiree, Subsidy Period, and Benefit Option 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?
When can the Covered Retiree List be downloaded?
The Covered Retiree List should be available for download within two business days from the time of the request.
Who should validate the Covered Retiree List?
The Covered Retiree List should be validated by the persons responsible for coordinating retiree eligibility for the Benefit Options within this Application. The Plan Sponsor must work with all cost reporters to ensure that the cost data being reported is only for the Qualifying Covered Retirees and Subsidy Periods listed in this file. Be sure that cost reporters are aware of the need to coordinate thresholds and limits within an Application for each Qualifying Covered Retiree. For more information about reporting cost data, go to: How should coordination of individual retiree cost data be handled?
What if I do not agree with the Covered Retiree List?
Prior to the completion of Step 4:
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 its updated internal records to the Covered Retiree List.
Submit an Add/Update/Delete 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.
OR - The Plan Sponsor's internal records still indicate that the beneficiaries have different approved Subsidy Periods under this Application.
OR - The Plan Sponsor is unable to process the Retiree Response and Weekly Notification Files for any reason.
If the above actions do not resolve the discrepancies, the Plan Sponsor should work with the beneficiary to validate all identifying information (for example, 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 CMS' RDS Center Help Line for assistance.
For more information about working with retiree files and notification files, go to: Submitting Retiree Files section of Chapter 7 and RDS Secure Website Weekly Notifications section of Chapter 9 in the RDS User Guide.
After the completion of Step 4:
Despite a Plan Sponsor's best efforts to ensure that the retiree data reflected in the Covered Retiree List is accurate, there may be instances where a Plan Sponsor becomes aware of changes to its Qualifying Covered Retirees after it has completed Step 3 and Step 4, but before it has completed Step 12: Review and Submit Reconciliation Payment Request. Such changes may include additions or deletions of Qualifying Covered Retirees, changes to the approved Subsidy Periods, and/or changes in which Benefit Option a Qualifying Covered Retiree is enrolled. In such cases, the Plan Sponsor must contact CMS' RDS Center Help Line prior to the completion of Step 12, to request that Step 3 and Step 4 be changed to an "Incomplete" status. When Step 3 and Step 4 are changed to an "Incomplete" status after they have been completed, ALL other Reconciliation steps that have already been completed, beginning with Step 3, will be changed to an "Incomplete" status and must be completed again. However, the Application's Reconciliation Deadline will not change. Please be aware that it will take CMS' RDS Center up to 5 business days to change Step 3 and Step 4 from "Complete" to "Incomplete" status.
Why is it important for the Covered Retiree List to be correct?
Federal law requires that cost data only be submitted for the Qualifying Covered Retirees, corresponding Subsidy Periods, and the Benefit Option(s) in which each Qualifying Covered Retiree is enrolled, as listed in the Covered Retiree List agreed to in Step 4. The Plan Sponsor should not complete Step 4 until it is certain that the retiree data reflected in the most recent Covered Retiree List is accurate.
For more information about correcting the Covered Retiree List, go to: What if I do not agree with the Covered Retiree List?
Can retirees or subsidy date ranges not on the Covered Retiree List be submitted for subsidy payment?
No. Cost data can only be submitted for the specific retirees and Subsidy Periods included in the Covered Retiree List.
Do I reconcile against the Covered Retiree List I am agreeing to?
Yes. After completing Step 4, CMS' RDS Center will validate all of the reported final cost data against the Covered Retiree List. Plan Sponsors are required to submit final cost data only for the Qualifying Covered Retirees, corresponding Subsidy Periods, and the Benefit Option(s) in which each Qualifying Covered Retiree is enrolled, as listed in the Covered Retiree List.
Can a Covered Retiree List be requested more than once?
Yes. A Covered Retiree List may be requested multiple times until Step 4 has been completed. However, only one Covered Retiree List may be requested per day.
How does a Plan Sponsor complete Step 4: Finalize Covered Retirees?
- Log into the RDS Secure Website.
- The Plan Sponsor List With Application Summary page displays. Select the appropriate Plan Sponsor ID.
-
The Application List page displays.
- From the Application List page, find the Application Number to reconcile. To access Reconciliation, select Reconciliation from the Actions dropdown and click Go.
- The Reconciliation Checklist page displays. Select Step 4: Finalize Covered Retirees.
- The Step 4: Finalize Covered Retirees page displays. To view retiree files provided by CMS' RDS Center, select Download Covered Retirees. For more information about downloading the Covered Retiree List, go to: Request and Download Covered Retiree Lists section of Chapter 10 in the RDS User Guide.
Note: To view the unique retiree counts per month on the Benefit Option Monthly Retiree Count page, select View Monthly Counts.
- The Benefit Option Monthly Retiree Count page will display. Select Continue to return to the previous page to review the retiree counts for each Benefit Option. Note: The Plan Year Retiree Count By Benefit Option table lists the different Benefit Options included in the Application with a link to View Monthly Counts for each Benefit Option.
- Click the checkbox to indicate that the warnings and instructions have been read. To finalize covered retirees, select Submit. To return to the Reconciliation Checklist without finalizing the list of covered retirees, select Cancel.
- The Step 4: Finalize Covered Retirees Verification page displays. To finalize covered retirees, select Confirm. To return to the Step 4: Finalize Covered Retirees page, select Cancel.
- The Step 4: Finalize Covered Retirees Confirmation page displays. The list of covered retirees for this Application is finalized. To return to the Reconciliation Checklist, select Continue.
- The Reconciliation Checklist displays. The status of Step 4: Finalize Covered Retirees changes to "Complete" and the Last Updated Date and Last Updated By fields are updated accordingly. Step 4 is marked with a green check to indicate that it is complete and Step 5 is marked with a blue arrow to indicate that it is the next step.
