RDS Reason Codes

00

Coverage Dates Accepted

Retiree Response File Only

Y

The row has been accepted by CMS' RDS Center.

No Action Required.

01

Missed Application Deadline

Retiree Response File Only

Blank

The Plan Sponsor did not meet Application Deadline requirements as specified in 42 C.F.R. §423.884(c).

Do not send retiree files for this application.

02

Invalid Application Number

Retiree Response File Only

Blank

The Application ID in the record sent is not a valid Application in the RDS System.

Ensure the Application ID is submitted EXACTLY as it appears on the RDS Secure Website.

03

Invalid Last Name

Retiree Response File Only

Blank

The Last Name field contains spaces or is numeric.

Verify the Last Name field does not contain spaces or numbers.

04

Invalid First Name

Retiree Response File Only

Blank

The First Name field contains spaces or is numeric.

Verify the First Name field does not contain spaces or numbers.

05

Invalid Date of Birth

Retiree Response File Only

Blank

The Date of Birth must be a valid date in CCYYMMDD format.

Verify the Date of Birth is formatted correctly.

06

Invalid Gender

Retiree Response File Only

Blank

The Gender must be:
Value '0' = Gender Unknown
Value '1' = Male
Value '2' = Female

Verify the Gender submitted matches one of the valid values.

07

Invalid Coverage Effective Date

Retiree Response File Only

Blank

The Coverage Effective Date must be a valid date in CCYYMMDD format.

Verify the Coverage Effective Date is formatted properly.

08

Invalid Coverage Termination Date

Retiree Response File Only

Blank

The date the beneficiary's (retiree, spouse, or dependent) coverage under the Plan Sponsor's Prescription Drug Benefit Option ends. Format: CCYYMMDD.

This field accepts 99999999 or may be left blank if the date is unknown.

Verify the Coverage Termination Date is formatted properly.

09

Invalid Unique Benefit Option Identifier

Retiree Response File Only

Blank

The Unique Benefit Option Identifier (UBOI) in the record you sent does not exactly match the UBOI on the application specified in this retiree file.

Verify that the UBOI is typed EXACTLY as it appears on the Benefit Options page.

10

Enrolled in Medicare Part D

Retiree Response File

Y

The beneficiary is not eligible for RDS subsidy for the entire Subsidy Period requested because the QCR is enrolled in Medicare Part D for some portion of the Subsidy Period.

Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the QCR for RDS subsidy.

10

Enrolled in Medicare Part D

Retiree Response File

N

The beneficiary is not eligible for RDS subsidy because they are enrolled in Medicare Part D during the entire period for which you requested coverage.

You may contact the beneficiary to discuss their Medicare Part D enrollment.

10

Enrolled in Medicare Part D

Notification File

Y

The beneficiary is not eligible for RDS subsidy for the entire Subsidy Period requested because the QCR is enrolled in Medicare Part D for some portion of the Subsidy Period.

Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the QCR for RDS subsidy. Internal records should be adjusted to ensure that costs are appropriately calculated.

10

Enrolled in Medicare Part D

Notification File

N

This beneficiary is no longer eligible for RDS subsidy because of enrollment in Medicare Part D during the entire Subsidy Period that was previously approved.

Internal records should be adjusted to ensure that costs are appropriately calculated.

10

Enrolled in Medicare Part D

Covered Retiree List

Y

The QCR is enrolled in Medicare Part D for some portion of the period of RDS coverage for which you previously applied or were approved.

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.

11

Not eligible for Medicare Part D

Retiree Response File

Y

The QCR is not eligible for Medicare for some portion of the Subsidy Period for which you have applied.

Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the QCR for RDS subsidy.

11

Not eligible for Medicare Part D

Retiree Response File

N

This beneficiary is not eligible for Medicare for the entire Subsidy Period for which you have applied.

You may wish to contact the beneficiary to discuss their Medicare Part entitlement and enrollment.

11

Not eligible for Medicare Part D

Notification File

Y

The QCR is not eligible for Medicare for some portion of the Subsidy Period for which they were previously approved.

Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the QCR for RDS subsidy. Update your internal records to reflect the change in RDS subsidy.

11

Not eligible for Medicare Part D

Notification File

N

The beneficiary is not eligible for Medicare Part D for the entire Subsidy Period for which they were previously approved.

This beneficiary is not eligible for RDS subsidy because they are not eligible for Medicare during the entire Subsidy Period that was previously approved.

11

Not eligible for Medicare Part D

Covered Retiree List

Y

The QCR is not eligible for Medicare Part D for some portion of the period of RDS coverage for which you previously applied or were approved.

Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the QCR for RDS subsidy.

12

Beneficiary is deceased

Retiree Response File

Y

The QCR's date of death falls within the Subsidy Period for which you have applied.

Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the QCR for RDS subsidy.

12

Beneficiary is deceased

Retiree Response File

N

This beneficiary is not eligible for subsidy because their date of death is prior to the Subsidy Period for which you have applied.

N/A

12

Beneficiary is deceased

Notification File

Y

The QCR's date of death falls within the Subsidy Period for which they were previously approved.

The previously approved Subsidy Period will have a new termination date. You should replace all coverage records.

12

Beneficiary is deceased: The beneficiary's date of death is prior to the Subsidy Period for which you have applied.

Notification File

N

This beneficiary is not eligible for subsidy because their date of death is prior to the Subsidy Period for which you were previously approved.

You should delete all Subsidy Periods.

12

Beneficiary is deceased: The beneficiary's date of death falls within the Subsidy Period for which you have applied.

Covered Retiree List

Y

The QCR's date of death falls within the period of RDS coverage for which you previously applied or were approved.

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.

13

Medicare beneficiary identifier or SSN is invalid.

Retiree Response File

N

A valid Medicare beneficiary identifier (MBI, HICN, or RRB), or SSN must be provided for the individual for whom the Plan Sponsor is seeking RDS subsidy.
 

Valid SSN:

• 9 numeric characters. Do not include hyphens or other special characters.
• Cannot contain all zeros.
• First three digits cannot be '666' or '900' - '999'.

Valid MBI:

• 11 alphanumeric characters.
• Cannot begin with 0.
• Must not start or end with two alphabetic characters.
• Must contain no more than 2 consecutive numbers.
• Must contain no more than 2 consecutive alphabetic characters.
• Must not contain the alphabetic characters S, L, O, I, B, Z.
• Must not contain lowercase letters.
• Do not include hyphens or other special characters.

Valid HICN:

• Consists of an SSN followed by an alpha or alphanumeric Beneficiary Identification Code (BIC)
• Characters 1-3 cannot be '000', '666', or '990' - '999'.
• Characters 4-5 cannot be '00'.
• Characters 6-9 cannot be '0000'.
• Character 10 must be a letter.
• Character 11 is dependent on character 10 (can be a space, letter, or number).
• Must not contain lowercase letters.
• Do not include hyphens or other special characters.

Valid RRB:

• Up to 12 alphanumeric characters
• 6 or 9 numeric characters preceded by one or more uppercase alpha characters.

Verify that the Medicare beneficiary identifier and/or SSN have been entered correctly.

14

Termination Date is less than Effective Date

Retiree Response File

N

The Coverage Termination Date submitted for this beneficiary is earlier than the Coverage Effective Date.

Verify the Coverage Termination Date.

15

Error occurred in header or trailer

Retiree Response File

N

Connect: Direct only.

Verify header or trailer.

16

Not a valid Medicare Beneficiary

Retiree Response File

N

This beneficiary was not found in the Medicare Beneficiary Database.

For more information about Reason Code 16, refer to Troubleshooting Retiree Response Files and Weekly Notification Files.

17

No Coverage Period exists for delete transaction.

Retiree Response File

N

CMS' RDS Center has made no update.

No Action Required.

18

Invalid Action Type

Retiree Response File

N

The action type must be: ADD, UPD, or DEL.

Verify the action type is ADD, UPD, or DEL.

19

Invalid relationship code

Retiree Response File

N

The relationship code must be:
Value '01' = Self
Value '02' = Spouse
Value '03' = Other

Verify the relationship code submitted matches one of the valid values.

20

Beneficiary attempted to enroll in Medicare Part D and received an initial rejection

Notification File Only

Blank

Beneficiary attempted to enroll in Medicare Part D and received an initial rejection.
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.

The Medicare Part D Enrollment Rejection Notification is your cue to contact the QCR who applied for Medicare Part D. You should explain to the QCR that your plan has equivalent or better drug coverage and the QCR does not need Medicare Part D. The notification is your indication that they have been initially rejected from Medicare Part D. If the QCR persists and enrolls in Medicare Part D, you will no longer be allowed to receive RDS subsidy for that individual.
There is no need to inform CMS' RDS Center of the contact with the QCR.

21

New Medicare information has been received: Resend this beneficiary's record to CMS' RDS Center.

Notification File Only

Blank

The Determination Indicator will be blank, and the subsidy dates will be set to zero. The new Medicare information may result in increased RDS subsidy coverage.

Re-submit this beneficiary in the next Monthly Retiree List.

24

Coverage Dates Outside the Plan Year

Retiree Response File Only

N

The entire Subsidy Period you requested for the beneficiary is outside the range of the plan year for the application, or
the Subsidy Period Termination Date requested is before January 1, 2006, the beginning of the RDS Program. 

Check to make sure the Plan Sponsor Coverage dates match the Plan Year Start and Plan Year End dates for the application submitted.

26

File Rejected - Denied Application

Retiree Response File

Blank

The status of the application for which this retiree file was submitted is Denied. This retiree file was not processed by CMS' RDS Center.

Do not send retiree files for this application.

26

File Rejected - Denied Application

Notification File

Blank

This application has been denied after retirees were previously approved for RDS subsidy. CMS' RDS Center has removed all RDS subsidy for this application.

Remove all RDS subsidy from your records for the beneficiaries, Benefit Options, and Subsidy Periods listed in this Notification File.
Do not send retiree files for this application.

27

File Rejected - Withdrawn Application

Retiree Response File

Blank

The status of the application for which this retiree file was submitted is Withdrawn. This retiree file was not processed by CMS' RDS Center.

Do not send retiree files for this application.

27

File Rejected - Withdrawn Application

Notification File

Blank

This application has been withdrawn after retirees were previously approved for RDS subsidy. CMS' RDS Center has removed all RDS subsidy for this application.

Remove all RDS subsidy from your records for the beneficiaries, Benefit Options, and Subsidy Periods listed in this notification file.
Do not send retiree files for this application.

28

File Rejected - Closed Application

Retiree Response File Only

Blank

The application for which this retiree file was submitted is past Reconciliation: Finalize Covered Retirees or the Reconciliation Deadline has passed. This retiree file was not processed by CMS' RDS Center.

Do not send retiree files for this application.

29

File Rejected - No Authority

Retiree Response File Only

Blank

The application for which this retiree file was submitted does not allow retiree files from this source or method. This retiree file was not processed by CMS' RDS Center.

Contact the Plan Sponsor associated with this application to discuss the authorized retiree list submission source and method.

30, 31

To Be Determined

Retiree Response and Notification Files

Blank

These reason codes are reserved for future use.

These will be informational only, similar to Reason Code 20. This record will not result in a subsidy change. It will likely require you to contact the specific beneficiary.

32

File Rejected - Appealed Application

Retiree Response File Only

Blank

The application for which this retiree file was submitted is in an appeal status. This retiree file was not processed by CMS' RDS Center.

Do not send retiree files for this application.

33

File Rejected - Deleted Application

Retiree Response File

Blank

The status of the application for which this retiree file was submitted is Deleted. This retiree file was not processed by CMS' RDS Center.

Do not send retiree files for this application.

33

Deleted Application

Notification File

Blank

The Application Status was set to Deleted after retirees were previously approved for RDS subsidy. CMS' RDS Center has removed all RDS subsidy for this application.

Remove all RDS subsidy from your records for the Beneficiaries, Benefit Options, and Subsidy Periods listed in this notification file.
Do not send retiree files for this application.

34

File Rejected - Abandoned Application

Retiree Response File

Blank

The status of the application for which this retiree file was submitted is Abandoned. This retiree file was not processed by CMS' RDS Center.

Do not send retiree files for this application.

34

Abandoned Application

Notification File

Blank

The Application Status was set to Abandoned after retirees were previously approved for RDS subsidy. CMS' RDS Center has removed all RDS subsidy for this application.
Note: Abandoned is a future application status and is not currently in use.

Remove all RDS subsidy from your records for the Beneficiaries, Benefit Options, and Subsidy Periods listed in this notification file.
Do not send retiree files for this application.

99

Subsidy Removed

Notification File Only

Y or N, depending on whether part or all of the RDS subsidy was removed

CMS' RDS Center has removed all or some period of the RDS subsidy previously approved for this Qualified Covered Retiree.

CMS' RDS Center will contact you about the actions you should take prior to sending this file.