During the Interim Payment process, Cost Reporters submit interim costs to CMS' RDS Center by either manual Data Entry on the RDS Secure Website or by Plan Sponsor Mainframe to RDS Center Mainframe through CMS Extranet. Submitted Interim Cost Reports are eligible to be included in an Interim Payment Request. It is critical for costs to be reported accurately for Qualifying Covered Retirees (QCRs) throughout the Plan Year to avoid an overpayment at Reconciliation.

Plan Sponsors have the option to receive interim subsidy payments throughout the Plan Year based on costs submitted to CMS' RDS Center. The Payment Frequency is selected during Application submission. Applications with a Payment Frequency of Monthly, Quarterly, or Interim Annual are eligible to receive interim payments.

Resources:

• For information about how to prepare interim costs, go to: How To Prepare RDS Cost Data For Submission To The RDS Center.
• For information about how to submit final costs, go to Chapter 6: Finalizing Costs For Reconciliation in the Reconciliation User Guide.

Interim Cost Reports may be submitted on Applications that meet all of the following conditions:

• Application must be in an "Approved" or "Approved Appeal" status.
• Payment Setup must be complete for the Application (Step 6 of the Payment Setup menu must have a "Complete" status).
• The Payment Frequency associated with the Application must be Monthly, Quarterly, or Interim Annual.

Note: Applications with an Annual Payment Frequency are not eligible for Interim Payment Requests and may only submit final costs during Reconciliation. The Payment Frequency selected at the time of Application submission cannot be changed for the duration of the Plan Year.

After Payment Setup is complete for the Application, the Interim Costs action is available in the Actions dropdown menu on the Application List page.

Cost Reporting Sources

Vendors and Plan Sponsors are the two types of sources that can report costs. Each source's costs are treated as separate and distinct from the costs submitted by another source.

A Plan Sponsor is considered a single source regardless of the number of individual Cost Reporters assigned to the Plan Sponsor, and a Vendor is considered a single source regardless of the number of individual Cost Reporters assigned to the Vendor.

Cost Reporters

A Cost Reporter may be the Account Manager, a Plan Sponsor Designee, a Vendor, or a Vendor Designee. Cost Reporters are assigned to a Benefit Option within an Application during the Payment Setup process.

Only Account Managers, Plan Sponsor Designees, and Vendor Designees may enter interim costs using the Data Entry submission method on the RDS Secure Website for those Benefit Options for which they have been assigned the Report Costs privilege in Payment Setup. These Cost Reporters are required to select an Application and Benefit Option prior to entering costs. Additionally, an audit trail of all Cost Reports either saved or submitted on the RDS Secure Website are viewable by Benefit Option.

The Cost Reporting method for Plan Sponsor Cost Reporters is specified in Payment Setup.

Vendors

A Vendor may report costs using the RDS Secure Website or Mainframe transmission. During registration with CMS' RDS Center, Vendors specify their Cost Reporting method and are assigned a Vendor ID. Each Vendor ID is then pre-associated with a Cost Report submission method as specified by the Vendor.

All Vendors must contact CMS' RDS Center Help Line to obtain a Vendor ID regardless of whether they are submitting Cost Reports using Mainframe or manual Data Entry on the RDS Secure Website.

For more information about Payment Setup including Cost Reporting User Roles, go to: How To Complete Payment Setup.

Methods For Submitting Interim Costs

Costs may be reported to CMS' RDS Center by two methods: Mainframe submission or Manual Data Entry submission using the RDS Secure Website. Any Cost Report that is submitted using a submission method other than the submission method indicated in the Payment Setup menu is rejected.

Note: For detailed information on Cost Reporting Methods, go to: How To Complete Payment Setup.

Preparing Interim Costs

The following cost figures must be aggregated by Benefit Option for each plan month:

Gross Retiree Costs – Non-administrative costs incurred under the plan for Medicare Part D drugs (as defined in 42 C.F.R. §423.100), whether paid by the Plan Sponsor or retiree or a combination. Gross Retiree Costs may not be reported if estimated premium has been reported for the Benefit Option.

Estimated Premium Cost – This amount is the portion of premium costs (excluding administrative costs, risk charges, etc.) paid by the Plan Sponsor and by the Qualifying Covered Retiree (QCR) that, based on a determination by the insurer using reasonable actuarial principles, is allocated to Gross Retiree Costs between the Cost Threshold and the Cost Limit.

Note: If Estimated Premiums are reported for interim cost reporting instead of Gross Retiree Costs, it must be consistently reported that way for the entire Plan Year. All reporting sources (Vendor or Plan Sponsor) for the Benefit Option also must consistently report that way for the entire Plan Year. Estimated Premiums may only be reported on Fully-insured plans.

Threshold Reduction – The amount below the Federally defined Cost Threshold is not eligible for the subsidy. Therefore Plan Sponsors must reduce the amount of gross covered retiree plan-related prescription drug costs. This ineligible subtracted amount is referred to as the Threshold Reduction.

Note: The Threshold Reduction is required for at least the first month in the Plan Year where gross costs were reported for CMS' RDS Center to accepted submitted costs. For subsequent months, the Threshold Reduction is not required; however, it must be provided as applicable.

Limit Reduction – The amount in excess of the Federally defined Cost Limit is not eligible for the subsidy. Therefore Plan Sponsors are not able to claim this excess amount of gross covered retiree plan-related prescription drug costs. This ineligible excess amount is referred to as the Limit Reduction.

Estimated Cost Adjustment – Estimate of the expected rebates and other price concessions (for example, discounts, chargebacks, etc.) attributable to the Gross Retiree Costs during the Plan Year between the Threshold Reduction and the Limit Reduction. This number is not applicable to 2005 plan months.

Note: If the Estimated Premium Cost Amount does not include the Estimated Cost Adjustment, then that sum must be reported separately when reporting costs on the RDS Secure Website.

For detailed information on how to prepare costs, go to: How To Prepare RDS Cost Data For Submission To The RDS Center.

The status of Cost Reports submitted by manual Data Entry or Mainframe to CMS' RDS Center may be viewed on the RDS Secure Website for current costs and previously reported costs. CMS' RDS Center does not send response files for submitted Cost Reports.

Notes:

• The Authorized Representative does not need to be verified for Interim Cost Reports to be accepted. For more information, go to Chapter 5: Register An Account Manager And An Authorized Representative in the RDS User Guide.
• For more information on viewing the most recent cost figures, go to: Viewing Current Costs On The RDS Secure Website.
• For information on how to view all Cost Reports submitted for a Benefit Option and a history of the actions taken on these reports., go to: Viewing The Cost Report Audit Trail On The RDS Secure Website.

Account Managers and Designees with the Report Costs privilege may view or report costs through the Benefit Option Interim Cost List page on the RDS Secure Website. The following Cost Report information for each Benefit Option is available on this page:

• Cost Reporting Source - Displays the Vendor Name and Vendor ID if a Vendor has been assigned the Report Costs privilege for the Benefit Option. Displays the user roles (Account Manager/Designee) assigned to directly report costs for the Plan Sponsor.
• Date of Last Report - Displays the date the Cost Reporter last saved cost figures or last submitted a Cost Report on the RDS Secure Website or the date a Mainframe submission containing costs for the Benefit Option was last processed.
• Status of Last Report - Displays the status of the last Cost Report.

• Data Entry: Saved - Data Entry status indicating that the last Cost Report was saved but not submitted.
• Data Entry: Submitted - Data Entry status indicating that the Cost Report was submitted and is now available to be included in a Payment Request.
• Mainframe: Submitted - Mainframe status indicating that the Cost Report was submitted and is now available to be included in a Payment Request.
• Mainframe: Errors Detected - Mainframe status indicating that errors were detected in the last report.
• No Reports - No Cost Reports have been processed (Mainframe) or saved/submitted (Data Entry).

Cost reporting months may be supplied in any order as long as the Plan Sponsor is not reporting costs for a month that has not yet occurred. For example, you cannot report costs for August if it is currently July. Also, if reporting multiple Application IDs or Benefit Options using the Mainframe, the Cost Reports do not have to be combined by Application ID or Benefit Option, as long as the reporting month is prior to the current month.

There is no limit to the number of Interim Cost Reports that may be submitted by a Cost Reporter. This flexibility is granted to ensure Plan Sponsors always report costs accurately.

The Account Manager with the Report Costs privilege and Designees with the Report Costs privilege may view the Audit Trail which includes Interim Cost Reports and Final Cost Reports.

Cost Reporters are required to re-supply the total costs aggregated for a month when previously reported costs for that month is adjusted or an erroneous report is detected by the Vendor or Plan Sponsor. Cost Reporters using Data Entry to submit costs may report corrected costs for a month by replacing previously reported costs and resubmitting the Cost Report on the RDS Secure Website.

Cost Reporters using Mainframe file submission may include corrected costs for prior months in the same file as new Cost Reports or provide separate files for corrected costs. If multiple files are sent, the last error-free record for the month is retained as the most recent costs for the month on the RDS Secure Website.

The following actions are prevented in Payment Setup after the Cost Reporter has submitted a Cost Report:

• Change Account Manager privilege from Report Costs to View Only or Request Payment
• Change Plan Sponsor Designee privilege from Report Costs to Request Payment
• Remove Vendor
• Remove Benefit Options from Cost Reporters (Vendor or Plan Sponsor)

Note: If Estimated Premiums are reported instead of Gross Retiree Costs, it must be consistently reported that way for the entire Plan Year. Also, all reporting sources (Vendor or Plan Sponsor) for the Benefit Option must also consistently report Estimated Premiums for the entire Plan Year.

To access the RDS Secure Website and navigate to the Application List page, go to: Appendix A: Access the RDS Secure Website in the RDS User Guide.

From the Application List page:

1. Find the appropriate Application ID.
2. Select Interim Costs from the Actions dropdown menu and select the Go button or select the Payment Setup link in the Payment Setup Status column.

Note: The Interim Costs action only displays in the Actions column for Account Managers and Designees assigned the Report Costs privilege during Payment Setup. The Interim Costs action do not display unless the Application is "Approved", Payment Setup is complete, and the Application payment frequency is Monthly, Quarterly, or Interim Annual.

On the Benefit Option Interim Cost List page:

3. Find the appropriate Benefit Option for which costs may be entered.
4. Select Enter/Update Costs from the Actions dropdown menu on the Benefit Option Cost Reporting Sources List table and select the Go button.

Note: The Enter/Update Costs action is only available if the Account Manager, Plan Sponsor Designee, or Vendor Designee is assigned the Report Costs privilege with a "Data Entry" method, and the last allowable Interim Payment Request has not been made for the Application.

On the Benefit Option Interim Cost Data Entry View page:

5. Select the edit link from the Benefit Option Interim Cost Report table to enter or modify a particular Plan Month/Year Benefit Option.

Note: The Benefit Option Interim Cost Data Entry View page contains the most recent interim costs saved to the RDS Secure Website. Costs may be added and edited for each month of the Plan Year from this page. Only one Month/Year may be edited at a time.

On the Benefit Option Interim Cost Data Entry Edit page:

An asterisk (*) indicates a required field.

6. Enter aggregated retiree data for the selected month in the following fields:

• * Estimated Premium Cost
• * Estimated Cost Adjustment (as applicable)

7. Select the Save button to save the entry or select the Cancel button to return to the Benefit Option Final Cost Data Entry View page without saving the information.

Notes:

• If Estimated Premium Costs are reported instead of Gross Retiree Costs, it must be consistently reported that way for the entire Plan Year. Also, all reporting sources (Vendor or Plan Sponsor) for the Benefit Option must also consistently report Estimate Premiums for the entire Plan Year. Estimated Premiums may only be reported on fully insured plans.
• If rebate and price concession data is included with the Estimated Premium Cost amount, do not report an Estimated Cost Adjustment amount.
• Each field must contain a zero, if there is no amount to report.

On the Benefit Option Interim Cost Data Entry View page:

8. Enter costs for all applicable plan months by repeating instructions 5 through 7.
9. Select the Return to Benefit Option List button to save costs but not submit it to CMS' RDS Center.

Notes:

• Costs may be entered and edited on this page as many times as necessary while the Cost Report is prepared for submission.
• (UPDATED) displays under the Month/Year when costs have been entered or updated.
• The reported costs may be submitted on the Benefit Option Interim Cost Data Entry View page using the Submit button. For information on how to submit the Cost Report, go to: Submitting Interim Cost Reports Entered Using Data Entry On The RDS Secure Website.

On the Benefit Option Interim Cost List page:

10. The Date of Last Report and the Status of Last Report columns on the Benefit Option Cost Reporting Sources List table are updated accordingly.
11. Select the Return to Application List button to return to the Application List page.

To access the RDS Secure Website and navigate to the Application List page, go to: Appendix A: Access the RDS Secure Website in the RDS User Guide.

From the Application List page:

1. Find the appropriate Application ID.
2. Select Interim Costs from the Actions dropdown menu and select the Go button or select the Payment Setup link in the Payment Setup Status column.

Note: The Interim Costs action only displays in the Actions column for Account Managers and Designees assigned the Report Costs privilege during Payment Setup. The Interim Costs action does not display unless the Application is "Approved", Payment Setup is complete, and the Application payment frequency is Monthly, Quarterly, or Interim Annual.

On the Benefit Option Interim Cost List page:

3. Find the appropriate Benefit Option for which costs may be entered.
4. Select Enter/Update Costs from the Actions dropdown menu on the Benefit Option Cost Reporting Sources List table and select the Go button.

Note: The Enter/Update Costs action is only available if the Account Manager, Plan Sponsor Designee, or Vendor Designee is assigned the Report Costs privilege with a "Data Entry" method, and the last allowable Interim Payment Request has not been made for the Application.

On the Benefit Option Interim Cost Data Entry View page:

5. Select the edit link from the Benefit Option Interim Cost Report table to enter or modify a particular Benefit Option Plan Month.

Note: The Benefit Option Interim Cost Data Entry View page contains the most recent interim costs saved to the RDS Secure Website. Costs may be added and edited for each month of the Plan Year from this page. Only one Month/Year may be edited at a time.

On the Benefit Option Interim Cost Data Entry Edit page:

An asterisk (*) indicates a required field.

6. Enter aggregated retiree data for the selected month in the following fields:

• * Gross Retiree Cost
• * Threshold Reduction
• * Limit Reduction
• * Estimated Cost Adjustment

7. Select the Save button to save the entry or select the Cancel button to return to the Benefit Option Final Cost Data Entry View page without saving the information.

Notes:

• The Threshold Reduction is required for at least the first month in the Plan Year where gross costs were reported. For subsequent months, the Threshold Reduction is not required; however, it must be provided as applicable.
• Each field must contain a zero, if there is no amount to report.

On the Benefit Option Interim Cost Data Entry View page:

8. Enter costs for all applicable months by repeating instructions 5 through 7.
9. After all costs are entered, select the Return to Benefit Option List button to save costs but not submit it to CMS' RDS Center.

Notes:

• Costs may be entered and edited on this page as many times as necessary while the Cost Report is prepared for submission.
• (UPDATED) displays under the Month/Year when costs have been entered or updated.
• The reported costs may be submitted on the Benefit Option Interim Cost Data Entry View page using the Submit button. For information on how to submit the Cost Report, go to: Submitting Interim Cost Reports Entered Using Data Entry On The RDS Secure Website.

On the Benefit Option Interim Cost List page:

10. The Date of Last Report and the Status of Last Report columns on the Benefit Option Cost Reporting Sources List table are updated accordingly.
11. Select the Return to Application List button to return to the Application List page.

Data Entry Cost Reports may be reported and saved on the RDS Secure Website. However, if the Cost Reports are not submitted, they cannot be included in an Interim Payment Request.

To access the RDS Secure Website and navigate to the Application List page, go to: Appendix A: Access the RDS Secure Website in the RDS User Guide.

From the Application List page:

1. Find the appropriate Application ID.
2. Select Interim Costs from the Actions dropdown menu and select the Go button or select the Payment Setup link in the Payment Setup Status column.

Note: The Interim Costs action only displays in the Actions column for Account Managers and Designees assigned the Report Costs privilege during Payment Setup. The Interim Costs action does not display unless the Application is approved, Payment Setup is complete, and the Application payment frequency is Monthly, Quarterly, or Interim Annual.

On the Benefit Option Interim Cost List page:

3. Find the appropriate Benefit Option for which costs may be entered.
4. Select Enter/Update Costs from the Actions dropdown menu on the Benefit Option Cost Reporting Sources List table and select the Go button.

Note: The Enter/Update Costs action is only available if the Account Manager, Plan Sponsor Designee, or Vendor Designee is assigned the Report Costs privilege with a "Data Entry" method, and the last allowable Interim Payment Request has not been made for the Application.

On the Benefit Option Interim Cost Data Entry View page:

5. Select the Submit button.

Note: The Benefit Option Interim Cost Data Entry View page displays a list of the most recent Interim Cost Reports for each month of the Plan Year. If interim cost figures have been saved for a plan month, (SAVED) displays under the Month/Year until the Interim Cost Report is submitted. Figures adjusted after submission of the Interim Cost Report appears with the word (UPDATED) in the plan month until the Interim Cost Report is resubmitted.

On the Benefit Option Interim Cost Data Entry Verification page:

6. Review the entries carefully to ensure that the data is correct and ready to be included in the Interim Payment Request.
7. Select the Confirm button to complete the submission process or select the Cancel button to return to the Benefit Option Interim Cost Data Entry View page without submitting the Cost Report.

On the Benefit Option Interim Cost Data Entry Confirmation page:

8. Print this page for your records.
9. Select the Continue button to return to the Benefit Option Interim Cost List page.

Note: The Interim Cost Report is submitted to CMS' RDS Center and is eligible to be included in an Interim Payment Request.

On the Benefit Option Interim Cost List page:

10. The Date of Last Report and the Status of Last Report columns on the Benefit Option Cost Reporting Sources List table are updated accordingly.
11. Select the Return to Application List button to return to the Application List page.

To access the RDS Secure Website and navigate to the Application List page, go to: Appendix A: Access the RDS Secure Website in the RDS User Guide.

From the Application List page:

1. Find the appropriate Application ID.
2. Select Interim Costs from the Actions dropdown menu and select the Go button or select the Payment Setup link in the Payment Setup Status column.

Note: The Interim Costs action only displays in the Actions column for Account Managers and Designees assigned the Report Costs privilege during Payment Setup. The Interim Costs action does not display unless the Application is approved, Payment Setup is complete, and the Application payment frequency is Monthly, Quarterly, or Interim Annual.

On the Benefit Option Interim Cost List page:

3. Find the appropriate Benefit Option for which costs may be entered.
4. Select Enter/Update Costs from the Actions dropdown menu on the Benefit Option Cost Reporting Sources List table and select the Go button.

Note: The Enter/Update Costs action is only available if the Account Manager, Plan Sponsor Designee, or Vendor Designee is assigned the Report Costs privilege with a "Data Entry" method, and the last allowable Interim Payment Request has not been made for the Application.

On the Benefit Option Interim Cost Data Entry View page:

5. Select the edit link from the Benefit Option Interim Cost Report table to modify a particular Benefit Option Plan Month.

Note: The Benefit Option Interim Cost Data Entry View page contains the most recent interim costs saved to the RDS Secure Website. Costs may be added and edited for each month of the Plan Year from this page. Only one Month/Year may be edited at a time.

On the Benefit Option Interim Cost Data Entry Edit page:

An asterisk (*) indicates a required field.

6. Enter the modified amount(s) for the selected month in the following fields:

• * Gross Retiree Cost
• * Threshold Reduction
• * Limit Reduction
• * Estimated Premium Cost
• * Estimated Cost Adjustment

7. To save changes, select the Save button to save the entry or select the Cancel button to return to the Benefit Option Final Cost Data Entry View page without saving the information.

Notes:

• If Estimated Premiums are reported instead of Gross Retiree Costs, it must be consistently reported that way for the entire Plan Year. Also all reporting sources (Vendor or Plan Sponsor) for the Benefit Option must also consistently report Estimated Premiums for the entire Plan Year. When reporting adjusted costs, always report the entire months' costs again, not just the adjusted amount.
• Each field must contain a zero, if there is no amount to report.

On the Benefit Option Interim Cost Data Entry View page:

8. Enter costs for all applicable months by repeating instructions 5 through 7.
9. After all costs are entered, select the Return to Benefit Option List button to save costs but not submit it to CMS' RDS Center.

Note: For information on how to submit the modified Cost Report, go to: Submitting Interim Cost Reports Entered Using Data Entry On The RDS Secure Website.

Costs reported by manual Data Entry and Mainframe submission may be viewed under the View Current Costs action. This action is not available when the Last Report Status is "Mainframe: Errors Detected" or "No Reports". The viewable Cost Summary displays the last accepted cost figures regardless if the costs are saved, submitted, and/or included in a previous Payment Request.

For information on how to view all Cost Reports submitted for a Benefit Option, go to: Viewing The Cost Report Audit Trail On The RDS Secure Website.

To access the RDS Secure Website and navigate to the Application List page, go to: Appendix A: Access the RDS Secure Website in the RDS User Guide.

From the Application List page:

1. Find the appropriate Application ID.
2. Select Interim Costs from the Actions dropdown menu and select the Go button or select the Payment Setup link in the Payment Setup Status column.

Note: The Interim Costs action only displays in the Actions column for Account Managers and Designees assigned the Report Costs privilege during Payment Setup. The Interim Costs action does not display unless the Application is "Approved", Payment Setup is complete, and the Application payment frequency is monthly, quarterly, or interim annual.

On the Benefit Option Interim Cost List page:

3. Find the appropriate Benefit Option for which costs may be entered.
4. Select View Current Costs from the Actions dropdown menu on the Benefit Option Cost Reporting Sources List table and select the Go button.

Note: There must be at least one successfully submitted Cost Report for the View Current Cost Action to display.

On the Benefit Option Interim Cost Summary page:

5. After viewing the last accepted costs, select the Continue button to return to the Benefit Option Interim Cost List page.

Note: The Benefit Option Interim Cost List page is View Only. To update For Mainframe Cost Reports, a new file must be submitted using the Mainframe submission method in order to modify the data. For information on updating Data Entry Cost Reports, go to: Updating Previously Reported Costs Entered Using Data Entry On The RDS Secure Website.

The Audit Trail of Benefit Option Interim Cost Reports page displays a list of the Benefit Option Cost Reports submitted to CMS' RDS Center by reporting source and a history of the actions taken on these reports. Each Cost Report submitted by manual Data Entry on the RDS Secure Website or Mainframe submission without critical errors is recorded in the Audit Trail. Cost Reports currently in “Data Entry Saved" or "Data Entry: Update/Entry Required" status are also included in the Audit Trail. The content of each Cost Report is available in the Audit Trail. The errors detected on Mainframe reports are listed on reports with a status of "Mainframe: Errors Detected".

For information on how to view Current Cost Reports submitted for a Benefit Option, go to: Viewing Current Costs On The RDS Secure Website.

To access the RDS Secure Website and navigate to the Application List page, go to: Appendix A: Access the RDS Secure Website in the RDS User Guide.

From the Application List page:

1. Find the appropriate Application ID.

2. Select Interim Costs from the Actions dropdown menu and select the Go button or select the Payment Setup link in the Payment Setup Status column.

Note: The Interim Costs action only displays in the Actions column for Account Managers and Designees assigned the Report Costs privilege during Payment Setup. The Interim Costs action does not display unless the Application is "Approved", Payment Setup is complete, and the Application payment frequency is Monthly, Quarterly, or Interim Annual.

On the Benefit Option Interim Cost List page:

3. Find the appropriate Benefit Option for which costs may be entered.
4. Select View Audit Trail from the Actions dropdown menu on the Benefit Option Cost Reporting Sources List table and select the Go button.

Note: There must be at least one successfully submitted Cost Report for the View Audit Trail Action to display.

On the Audit Trail of Benefit Option Interim Cost Reports page:

The following information displays on the Audit Trail of Benefit Option Interim Cost Reports page for each action taken on a submitted Cost Report.

• Date/Time Processed – Displays the date and time CMS' RDS Center processed a Cost Report when an action was taken by a Cost Reporter or Payment Requester.
• Status – Displays the status of the Cost Report based on the action that was taken.
• Data Entry: Submitted – Data Entry status indicating that the Cost Report was submitted on the RDS Secure Website.
• Mainframe: Submitted – Mainframe status indicating that the Cost Report was submitted without errors.
• Mainframe: Errors Detected – Mainframe status indicating that the Cost Report was submitted with errors.
• Included In Payment Request – Indicates that the Cost Report was included in a Payment Request.
• Report Reviewed – Indicates that the Payment Requester reviewed the Cost Report.
• Date/Time File Created (Mainframe Submission Only) – Displays the date and time supplied in the Mainframe file submission.

• Cost Reporter / Payment Requester – Displays the name of the individual who reported costs on the RDS Secure Website, reviewed the Cost Report, or submitted the Payment Request.
• Errors/Warnings Detected – Displays the number of errors and warnings detected in a Mainframe Cost Report. The number of errors only appears if the status of the Cost Report is "Mainframe: Errors Detected“. Data Entry submissions with errors are not permitted on the RDS Secure Website.

5. Select View Cost Reports from the Actions dropdown menu on the Audit Trail of Benefit Option Interim Cost Reports table and select the Go button.

On the Benefit Option Interim Cost Report page:

6. After viewing the Cost Report, select the Continue button to return to the Audit Trail of Benefit Option Interim Cost Reports page.

Vendors and Plan Sponsors may send Mainframe cost files:

• A Vendor file may contain Cost Reports for multiple Plan Sponsors, Applications, and Benefit Options.
• A Plan Sponsor file may contain Cost Reports for multiple Applications and Benefit Options, but only for a single Plan Sponsor.
• Both Vendor and Plan Sponsor files may report multiple months of costs for a single Benefit Option and may include multiple Benefit Options and Applications.

Vendors must register with CMS' RDS Center to report costs and specify their reporting method. If reporting costs by Mainframe submission, an RDS Electronic Data Interchange (EDI) Representative assists the Vendor to establish the proper connection, file names, and file structure. This setup must be completed once for each Vendor. Before transmitting production data to CMS' RDS Center using the Mainframe submission method, contact CMS' RDS Center Help Line for information about how to send test files to ensure that proper connectivity is established.

A Vendor file may contain Cost Reports for multiple Plan Sponsors, Applications, and Benefit Options. The Vendor must be assigned to the proper Benefit Option in Payment Setup for CMS' RDS Center to accept a Mainframe Cost Report from a Vendor. The Plan Sponsor can assign a Designee to a Vendor reporting Mainframe costs in Payment Setup. The Report Costs privilege allows the Designee to view all Cost Reports sent by that Vendor that did not have critical errors.

Plan Sponsors that report costs by Mainframe submission must contact CMS' RDS Center Help Line to establish the proper connection, file names, and file structure. A Mainframe file reported by a Plan Sponsor may contain Cost Reports for multiple Applications and Benefit Options, but only for a single Plan Sponsor. For CMS' RDS Center to accept a Mainframe Cost Report, the Mainframe method must be assigned to the Plan Sponsor's Cost Reporter (Account Manager or Designee) in Payment Setup and the Plan Sponsor's Cost Reporter must be assigned to the proper Benefit Option.

When a Cost Report is received using the Mainframe, the data cannot be modified on the RDS Secure Website. An audit trail of all Cost Reports "accepted" by the Mainframe is viewable on the RDS Secure Website by Benefit Option.

The overall Mainframe Cost Report file format is as follows:

• File organization – Sequential
• Record Format (RECFM) – Fixed (F) or Fixed Blocked (FB)
• Record Length (LRECL) - 110 bytes
• Block Size (BLKSIZE) - Determined by the sender's system

Note: File Header (FHDR) information, File Creation Time must be preceded by leading zeros if time is less than 8 bytes (to prevent time as "8:11:11")

For more information about the Mainframe Cost Report File format, review the Mainframe Report File Elements.

For more information about the Mainframe copybook, review the Cost Report Copybooks.

For more information about the Mainframe cost file, review the Sample Mainframe Cost File.

More than one Application ID may be submitted in the same file, but they must be separated by an Application Trailer and start with another Application Header. Finally, multiple months of cost data may be submitted for the same Unique Benefit Option Identifier (UBOI), but they must be in separate detail lines.

Files may contain interim costs and final costs for separate Applications. When submitting final costs, all months in the Plan Year must be submitted between a single set of Application Header and Application Trailer records.

A Vendor or a Plan Sponsor reporting costs by Mainframe submission must submit aggregated retiree costs per Benefit Option for all Application plan months. Costs submitted using the Mainframe is viewable on the RDS Secure Website; however, the costs reported using the Mainframe cannot be changed using the RDS Secure Website. To revise costs originally submitted by Mainframe, the revised costs files must be resubmitted using the Mainframe connection. This new data displays on the RDS Secure Website.

If the Mainframe Final Cost Report was received and had no critical errors, it displays on the RDS Secure Website approximately 24 to 48 hours after it was sent. Accepted Cost Reports display with a status of “Mainframe: Submitted“.Cost Reports that are rejected for non-critical errors display with a status of “Mainframe: Errors Detected".

Mainframe Cost Reports Rejected By CMS' RDS Center

If the Mainframe file was received, and there were critical errors that prevented it from being processed, an RDS Electronic Data Interchange (EDI) Representative then contacts the submitter to discuss the errors. As a result, the Cost Reports are not viewable on the RDS Secure Website.

The following error conditions are considered critical:

• The Vendor ID is not found in the RDS database
• The Plan Sponsor ID is not found in the RDS database
• A field has an invalid format
• Negative numbers reported in any field
• The file format is invalid
• Trailer totals (Application and File) do not match the sum of the detail records
• The created date and time are earlier than the last processed date and time
• The Application ID is not found in the RDS database
• The Application ID is not associated with the Plan Sponsor
• The Unique Benefit Option Identifier (UBOI) is not associated with the Application
• If a Vendor submits a Mainframe Cost Report and is not properly setup on the Application or Benefit Option in Payment Setup, the Cost Report is rejected with the following errors:

• The Cost Report is not viewable on the RDS Secure Website.
• The Vendor is not currently listed as a Cost Reporter on the Application
• The Vendor is not currently a Cost Reporter for the Unique Benefit Option Identifier (UBOI)

Note: A cost file with any of the above-mentioned critical error conditions must be corrected and resubmitted to CMS' RDS Center.

Cost Reports that are rejected by CMS' RDS Center for non-critical errors receive a status of “Mainframe: Errors Detected" and are viewable from the Benefit Option Final Costs list. Specific information about the file, Cost Report, and the corresponding errors can be viewed on the Audit Trail page.

The following error conditions are considered non-critical but prevents the cost file from being accepted to be included in a Payment Request. These error conditions must be corrected and the cost file must be resubmitted:

• Payment Setup is not complete for the Application
• The Vendor or Plan Sponsor's reporting method specified in Payment Setup is Data Entry
• The month/year reported falls outside of the Application Plan Year
• Costs are supplied for a future month
• Estimated Premium Costs are provided for self-insured Benefit Options
• The last available Interim Payment Request was made for the Application and not cancelled. If Interim Annual, one Payment Request is allowed. If Monthly, twelve Payment Requests are allowed. If Quarterly, four Payment Requests are allowed.

Note: One-time payment counts toward the maximum number of Payment Requests

• The Estimated Cost Adjustment is reported for a month prior to January 2006
• Costs are greater than zero and an eligible retiree does not exist for the Unique Benefit Option Identifier (UBOI) with coverage effective dates that fall within the Plan Year.

Note: Zero costs are accepted for a UBOI without an eligible retiree

The following error conditions prevents the cost file from being accepted as an error-free cost file for inclusion in a Payment Request. Interim cost files with the following error conditions may not be viewed in the Audit Trail:

• The Vendor is not currently listed as a Cost Reporter on the Application
• The Vendor is not currently a Cost Reporter for the Unique Benefit Option Identifier (UBOI)

Note: A cost file with any of the above-mentioned error conditions needs to be corrected and resubmitted to CMS' RDS Center.