How To Download Weekly Notification Files - Updated 01/31/2008
The following document describes the RDS Secure Web Site weekly notification file process and step-by-step instructions on how to download weekly notification files using the RDS Secure Web Site. Specifically, this document includes information about the following:
- What terminology do I need to understand the Weekly Notification File process?
- How do I access the download Weekly Notification File feature in the RDS Secure Web Site?
- How do I download a Weekly Notification File?
- What if there are no Weekly Notification Files available for download?
- How will I know when the Weekly Notification Files are available for download?
- What is the naming convention of the Weekly Notification File?
- What data is being sent in the Weekly Notification File?
- Why are Medicare Part D enrollment rejection notifications not e-mailed directly to the Plan Sponsor?
- What do I do if a retiree now has RDS subsidy coverage that is less than the original RDS subsidy coverage?
- Why does one of my retirees no longer have coverage?
- What do I do if a retiree has a reason code 20?
- What do I do if a retiree has a reason code 21?
- Why do some of my retirees have a reason code 12 and their Subsidy Period Termination Date is the end of the month?
What terminology do I need to understand the Weekly Notification File process?
Qualifying Covered Retiree - A Medicare 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 Medicare 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 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 upload 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.
How do I access the download Weekly Notification 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 dropdown list and click the Go button.
- Application Status page - select the Manage Retirees link.
- From the Manage Retirees page select the Download Weekly Notifications link.
How do I download a Weekly Notification File?
- On the Download Weekly Notification File page locate the file you wish to download and double click on it.
- The File Download window will display showing the progress of the download.
- Depending on your browser settings the file download window may close automatically when the download is complete or you may need to close it manually.
- You may now download another file or click the Return to Manage Retirees button.
What if there are no Weekly Notification Files available for download?
If there are no Weekly Notification Files available to download it could be because none of the beneficiaries covered under that application have had notification events. Events may include, but are not limited to: a change in Medicare entitlement, the death of beneficiary, or enrollment in Medicare Part D.
If the elected file submission method for the application is Mainframe-to-Mainframe or VDSA you will never see Weekly Notification Files on the RDS Secure Web Site. Weekly Notification Files are sent to the Plan Sponsor based on the elected retiree file submission method on the application.
How will I know when the Weekly Notification Files are available for download?
The Account Manager and Designee, with file submission privileges, will receive an e-mail indicating that weekly notification files are available for download. This e-mail process is effective 12/15/2005. Any weekly notification files delivered by CMS' RDS Center prior to 12/15/2005 will not have an associated e-mail.
What is the naming convention of the Weekly Notification File?
The Weekly Notification File name will include the Plan Sponsor ID, Application ID, and Creation date. For example Notify_12345_6789_20051118 would be the Weekly Notification File for Plan Sponsor 12345 application 56789 created on 11/18/2005 (20051118).
What data is being sent in the Weekly Notification File?
When CMS' RDS Center receives notifications from Medicare the system re-evaluates the beneficiary's eligibility for subsidy. Each notification that affects your ability to collect subsidy for a beneficiary is reported in the Weekly Notification File. The notification records will contain all the original data elements that you sent in your retiree file, plus the determination indicator, reason codes, subsidy period effective date, and the subsidy period termination date. However, the "transaction type" data element will be left blank. Refer to How to Upload a File for detailed information about the Retiree Record Layout. The Plan Sponsor may receive multiple notification records for a single beneficiary in the event that there is a gap in RDS Coverage Periods. If the notification event results in a change to the subsidy period new dates will be reported in the file. If the notification event is regarding the beneficiary's initial application for Medicare Part D or is a change that may result in an increased subsidy period the original subsidy period effective and termination dates will be reported in the file.
Note: Notification files must be processed by Plan Sponsors and subsidy periods posted in their internal systems so that the appropriate payment calculations may be performed.
Weekly notifications from RDS to Plan Sponsors - Download file via the Secure Web Site
| Data element | Max size | Notes |
|---|---|---|
| Determination Indicator | 01 | Y = Yes, the retiree qualifies for an RDS subsidy period N = the Retiree does not qualify for an RDS subsidy period Blank – The RDS subsidy determination indicator is unchanged since the last retiree response file |
| 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 populated 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 populated in combination with specific scenarios. |
| 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 have applied. If you get a Determination Indicator "Y", this means that this beneficiary is enrolled in Medicare Part D during a portion of the period when you have requested to claim the RDS subsidy for this beneficiary. If there is a Determination Indicator "Y", you should refer to the Subsidy Period Effective date and Subsidy Period Termination Date for the period that you may claim the beneficiary for the RDS subsidy. If you get a Determination "N", this means this beneficiary is not eligible for RDS subsidy because h/she is enrolled in Medicare Part D during the period you requested coverage. 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 all or some portion the period of RDS coverage for which you were previously approved for subsidy. If you get this code and a Determination Indicator Y, check the Subsidy Period Effective and End date for changes. You may receive multiple records for the same beneficiary. If you get this code in combination with a Determination Indicator "Y" you should remove all RDS coverage because this beneficiary is no longer eligible for RDS 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 have applied. The beneficiary's death has been reported to the RDS Center by MBD. If you get this code and a Determination Indicator "Y" your previously approved subsidy period will have a new termination date. You should replace all coverage records. You may receive multiple records for the same beneficiary. If you get this code and a Determination Indicator "N" your RDS coverage period for this beneficiary begins on a future date (after the date of death). You should delete all subsidy periods. Disclaimer: Due to the sensitive nature of this information, CMS' RDS Center is not at liberty to discuss specific entitlements with Plan Sponsors. |
| 20 | Beneficiary attempted to enroll in Medicare Part D and received initial rejection. The notification is your cue to contact the beneficiary who applied for Medicare Part D. You should explain to the beneficiary that h/she has equivalent or better drug coverage under your plan and that h/she does not need Medicare Part D. The notification is your indication that they have been initially rejected. If the beneficiary persists and enrolls in Medicare Part D you will no longer be allowed to receive a subsidy payment for them. The determination indicator will be blank and the subsidy dates will be set to zero. The previously approved subsidy will not change. |
| 21 | New Medicare information has been received. Resend this beneficiary's record. The determination indicator will be blank and the subsidy dates will be set to zero. The new Medicare information may result in increased subsidy coverage. Re-submit this beneficiary in your next monthly add/update/delete retiree file. |
Note: CMS' RDS Center will only send a notification for retirees who have ever qualified for an RDS subsidy period. If the retiree never qualified for the RDS subsidy (regardless of the reason), a notification will not be generated.
Why are Medicare Part D enrollment rejection notifications not e-mailed directly to the Plan Sponsor?
The information contained in the beneficiary notifications are classified as Protected Health Information (PHI) and fall under the jurisdiction of Title II, Subtitle F, of the Health Insurance Portability and Accountability Act Of 1996 (HIPAA). As such, this information is protected and transmission and maintenance of it is closely regulated. The methods that CMS' RDS Center uses to disseminate retiree notifications have been selected to best comply with these regulations.
What do I do if a retiree now has RDS subsidy coverage that is less than the original RDS subsidy coverage?
If the retiree has RDS coverage (even in the past) that is less than the original RDS coverage the, RDS Center considers this a complete replacement of coverage. There will be one record sent per unique benefit option identifier (UBOI) for which the beneficiary was previously covered.
This problem will result in one of the following reason codes: Code 10 – Enrolled in Medicare Part D, Code 11 – Not eligible for Medicare, or Code 12 – Beneficiary is Deceased and the Determination Indicator will be set to Y.
Why does one of my retirees no longer have coverage?
If a retiree once had coverage, but this week's notification indicates otherwise, the RDS Center considers this a complete cancellation of coverage. There will be one record sent per unique benefit option identifier (UBOI) for which the beneficiary was previously covered.
This problem will result in one of the following reason codes: Code 10 – Enrolled in Medicare Part D, Code 11 – Not eligible for Medicare, or Code 12 – Beneficiary is Deceased and the Determination Indicator will be set to N.
What do I do if a retiree has a reason code 20?
If a retiree has a reason code 20– Beneficiary attempted to enroll in Medicare Part D and received initial rejection. The Medicare Part D enrollment rejection notification is intended to give Plan Sponsors an opportunity to contact the retirees and discuss the potential impact (if any) that a completed Part D enrollment would have on their retiree coverage under the terms of the Plan Sponsor's plan. For the Sponsor, a beneficiary's enrollment in Medicare Part D will result in that beneficiary's RDS coverage periods terminating. The determination indicator will be blank and the subsidy dates will be set to zero. (However, the Sponsor will still be entitled to subsidy payments for other qualifying covered retirees.)
What do I do if a retiree has a reason code 21?
If a retiree has a reason code 21 - New Medicare information, this means the RDS Center has received new Medicare information about this retiree that may affect eligibility. Plan Sponsors must resubmit the retiree in the next monthly add/update/delete retiree file. With reason code 21 in a notification file, the RDS Center will never send increased coverage period.
Why do some of my qualifying covered retirees have a reason code 12 and their Subsidy Period Termination Date is the end of the month?
If a retiree has a reason code 12 - beneficiary is deceased, some of your 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 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 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 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.
