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Retiree files must be sent to CMS' RDS Center throughout the Application Lifecycle to establish and maintain Qualifying Covered Retirees (QCRs) for an application. Several methods of submission are available for exchanging retiree information with CMS' RDS Center, with copies of the files sent to the RDS Secure Website.
Review this section to learn about:
- Retiree List Submission Methods and Retiree List Response Methods
- Exchanging and Protecting Retiree Information
- Valid Initial Retiree List
- Monthly Retiree List
- Upload Retiree Files on the RDS Secure Website
- Display List of Uploaded Retiree Files
- Send Retiree Files by Connect:Direct or COB
- Retiree Processing and Reconciliation
Retiree List Submission Methods and Retiree List Response Methods
The Retiree Submission Method is selected in the Benefit Options step of the Application Submission Process.
Note: After an application is in "Submitted" status, the Plan Sponsor can return to Benefit Options to change the Retiree Submission Method.
Retiree Submission Methods:
- RDS Secure Website to RDS Center
- Vendor Connect:Direct to RDS Center Connect:Direct
- Voluntary Data Sharing Agreement (VDSA) through CMS' Coordination of Benefit (COB) Contractor
- Plan Sponsor Connect:Direct to RDS Center Connect:Direct
Exchanging and Protecting Retiree Information
CMS' RDS Center uses the current Retiree Submission Method to determine which file transfer method to use in order to send the Weekly Notification File to the Plan Sponsor. If the retiree information does not match the source and data exchange method chosen by the Plan Sponsor for each Benefit Option, it is not processed.
If the RDS Secure Website to RDS Center submission method is specified by the Plan Sponsor, only the Authorized Representative, the Account Manager, and Designee with the View/Send/Receive Retiree Data privilege may upload retiree data on the RDS Secure Website, and view response files sent to the RDS Secure Website. Retiree data sent by any other method is not processed, and a response file is sent back to the source with the appropriate reason code.
If a Retiree Submission Method other than RDS Secure Website is specified by the Plan Sponsor, the RDS Secure Website prevents the upload of retiree data. Retiree data sent by any other source (Plan Sponsor, Vendor, or COB contractor) is not processed, and a response file is sent back to the source with the appropriate reason code.
Weekly Notifications are sent to the RDS Secure Website for all Retiree Submission Methods. Weekly Notifications are only sent to Vendors, COB contractors, or the Plan Sponsor's Connect:Direct if the most current retiree data was received and processed from that source, and when the Plan Sponsor's current Retiree Submission Method specifies that source and data exchange method.
Valid Initial Retiree List
The Valid Initial Retiree List is the first transfer of retiree information from the Plan Sponsor to CMS' RDS Center. The Valid Initial Retiree List is a collection of data about the beneficiaries for whom the Plan Sponsor is seeking subsidy.
A Valid Initial Retiree List can be submitted to CMS' RDS Center after an application has been started and an Application ID has been assigned, Benefit Options have been established, and the Retiree Submission Method has been selected. The file will not be processed, however, until the application is submitted by the Authorized Representative.
A Valid Initial Retiree List and subsequent retiree files are exchanged using the selected Retiree Submission Method chosen for the Benefit Option. In the Valid Initial Retiree List, each beneficiary (retiree, spouse, or dependent) should have at least one detail record or row in this file. If a beneficiary has more than one coverage period or Benefit Option within the Plan Sponsor's drug plan, a record must be sent for each Benefit Option and coverage period combination.
The Valid Initial Retiree List should include the retiree information available to date. If there is outstanding retiree information that prohibits sending a beneficiary with the Valid Initial Retiree List, the beneficiary's information can be sent in a future Monthly Retiree List.
A Retiree Response File is sent by CMS' RDS Center in response to the Valid Initial Retiree List submitted by the Plan Sponsor.
Monthly Retiree List
Changes to retiree information throughout the plan year for a given application should be included in Monthly Retiree Lists. The Monthly Retiree List is submitted by a Plan Sponsor or Vendor for a given application to maintain accurate beneficiary data.
The first Monthly Retiree List should be sent to CMS' RDS Center approximately 30 days from the date the initial Retiree Response File was received and processed by the Plan Sponsor or Vendor. This list must be in the same format as the Valid Initial Retiree List, with only detail records of beneficiaries having a change of information.
A Monthly Retiree List is not required if no information has changed for a given month.
A Retiree Response File is sent for each Monthly Retiree List received by CMS' RDS Center.
Upload Retiree Files on the RDS Secure Website
The Valid Initial Retiree List and Monthly Retiree Lists may be uploaded to CMS' RDS Center using the Retiree and Response Files page on the RDS Secure Website, if all Benefit Options are set to the RDS Secure Website submission method. If any Benefit Option contained in the Retiree List is set to a submission method other than the RDS Secure Website, the RDS Secure Website will prohibit upload of the entire file.
Display List of Uploaded Retiree Files
The successfully uploaded Valid Initial Retiree List and all successfully uploaded Monthly Retiree List files are displayed on the Retiree and Response Files page. A retiree file does not appear in the list if:
- Retiree files were submitted to CMS' RDS Center by Mainframe, COB:VDSA, or COB:MIR; or
- Retiree files had critical errors during the upload.
Send Retiree Files by Connect:Direct or Coordination of Benefits (COB)
The Valid Initial Retiree List and Monthly Retiree List files may be sent to CMS' RDS Center using a Vendor Connect:Direct connection to the RDS Center Connect:Direct, or a Coordination of Benefits (COB): Voluntary Data Sharing Agreement (VDSA) or Mandatory Insurer Reporting (MIR), or using a Plan Sponsor Connect:Direct connection to the RDS Center Connect:Direct.
If a retiree file is submitted using Vendor Connect:Direct to RDS Center Connect:Direct method or Plan Sponsor Connect:Direct to RDS Center Connect:Direct method, any records containing a Benefit Option that does not match the Connect:Direct submission method/source will be returned on the Retiree Response File with a Reason Code 29: File Rejected - No Authority.
If a retiree file is submitted using Voluntary Data Sharing Agreement (VDSA) through CMS' Coordination of Benefit (COB) Contractor method, any records containing a Benefit Option that does not match the Voluntary Data Sharing Agreement (VDSA) through CMS' Coordination of Benefit (COB) Contractor method will be returned on the Retiree Response File with a Reason Code 29: File Rejected - No Authority.
Retiree Processing and Reconciliation
When Reconciliation: Finalize Covered Retirees is marked "Complete" or the Reconciliation Deadline has passed for that application, the Plan Sponsor is unable to upload retiree files through the RDS Secure Website. CMS' RDS Center will continue to send Retiree Response Files for every retiree file that is received via Connect:Direct, VDSA, or MIR, even after Reconciliation: Finalize Covered Retirees is marked "Complete." However, no changes will be made to the Qualified Covered Retirees (QCRs) for such applications, and all records will be returned on the Retiree Response File with a reason code explaining the reason for rejection. Weekly Notification Files are not sent after Reconciliation: Finalize Covered Retirees is marked complete.
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