How to communicate retiree information using the Mainframe- Updated 01/31/2008
The following document describes how to communicate retiree information with the RDS Center via Mainframe-to-Mainframe Connect:Direct submission method. This document is divided into three sections: Retiree File Submission to the RDS Center, Retiree Response Files from the RDS Center, and Weekly Notification Files from the RDS Center.
Retiree File Submission to the RDS Center
This section addresses the questions and the processes around Retiree File Submission such as setting up mainframe-to-mainframe connectivity, retiree file layout, sending retiree files, and more.
- What terminology do I need to understand to send retiree files via Mainframe-to-Mainframe Connect:Direct using AT&T Global Network Services (AGNS)?
- How do I indicate I would like to send retiree information Mainframe-to-Mainframe?
- What setup is required to send retiree files via Mainframe-to Mainframe Connect:Direct submission method?
- What do I need to do to maintain my Mainframe-to-Mainframe communications with the RDS Center?
- What if I do not have all the required information for all the qualified covered retirees for whom I would like to request the subsidy?
- How should my retiree file look?
- When using Mainframe-to-Mainframe connection, may I transmit retiree information for more than one application in the same file?
- When using Mainframe-to-Mainframe connection, may multiple retiree files be sent for the same application from different sources?
- How will I know if my mainframe retiree file was rejected?
- Where can I view the Retiree List Copybook?
What terminology do I need to understand to send retiree files via Mainframe-to-Mainframe Connect:Direct using AT&T Global Network Services (AGNS)?
Qualifying Covered Retiree - A 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 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 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/her dependent(s)) should have 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 retransmit 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, disannulment, 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 indicate I would like to send retiree information Mainframe-to-Mainframe?
If you want to send your retiree information to the RDS Center via Mainframe-to-Mainframe, you need to select the mainframe submission method when completing the Retiree List Submission Method section of the application (instructions are provided below).
Note: If you change your Retiree List Submission Method from RDS Secure Web Site (file upload) to Mainframe-to-Mainframe, do not change the retiree submission method until the appropriate mainframe connections to the RDS Center are established and tested. Changing your retiree submission method before the new connection is established will jeopardize the weekly notification file process. The RDS Center uses the current retiree submission method to determine which file transfer method to use to send the weekly notification file to the Plan Sponsor. Consequently, if you select Mainframe-to-Mainframe before the connection is successfully established, the RDS Center will be unable to send the weekly notification file to the Plan Sponsor until the Mainframe-to-Mainframe is established, or until the retiree file submission method is changed back to RDS Secure Web Site.
In addition, if you change your Retiree Submission Method to Mainframe-to-Mainframe or switch Vendors, once your new connection is established you are required to submit a new valid initial retiree file to the RDS Center using the new submission method. When sending Mainframe-to-Mainframe, each retiree must be associated with a Vendor or a Plan Sponsor in order to receive weekly notification files. This will ensure that information on your retirees and communications from the RDS Center about them will be accurate and up-to-date.
For instructions on how to select the Mainframe-to-Mainframe submission method in your application, follow the steps below:
- On the Application Status page, click the Retiree List Submission Method link.
- The Retiree List Submission Method page will display. Select the Plan Sponsor Mainframe to RDS Center Mainframe radio button and click Continue. Clicking Cancel will return you to the Application Status page.
- The Send file mainframe to mainframe via AGNS section will display.
- Enter your Technical Contact information in the fields and click Continue. Clicking Cancel will return you to the Application Status page without saving your information.
- The Application Status page will display. Notice that the Retiree List Submission Method status will be Complete.
What setup is required to send retiree files via Mainframe-to Mainframe Connect:Direct submission method?
Setup is required before you can send retiree files via Mainframe-to Mainframe Connect:Direct submission method. When setting your Retiree List Submission Method you will need to identify a Technical Contact and provide the following information about that person: First Name, Last Name, Telephone, Fax, and E-mail Address. The RDS Center will contact Technical Contact to set up and test your connection.
The time frames for Connect:Direct setup vary depending on the Plan Sponsor's current use of AT&T Global Network Services (AGNS).
- For Plan Sponsors with an existing AGNS account and an existing connection to the RDS Center, the setup will take 1 to 2 weeks.
- For Plan Sponsors with an existing AGNS account, but no existing connection to the RDS Center, the setup will take 1 to 2 months.
- For Plan Sponsors without an AGNS account, the setup will take 2 to 3 months.
What do I need to do to maintain my Mainframe-to-Mainframe communications with the RDS Center?
You must inform the RDS Center of each application for which you will submit files via your Mainframe-to-Mainframe connection. This is especially important when you begin a new plan year and create a new application(s). Be prepared to provide the RDS Center with the proper documentation.
In addition, if you are a Vendor submitting retiree information for one Plan Sponsor and want to start sending retiree information for another Plan Sponsor, you need to contact the RDS Center.
What if I do not have all the required information for all the qualified covered retirees for whom I would like to request the subsidy?
Keep in mind that the valid initial retiree list should include the retiree information you have to date. If you have outstanding retiree information that prohibits you from sending an individual with the valid initial retiree list, you can send that information during the monthly add/update/delete retiree file process.
How should my retiree file look?
Following is the retiree file layout for Retiree Lists from Plan Sponsors to RDS via Mainframe-to-Mainframe Connect:Direct.
Please see the Retiree File Layout Copybook for more information.
- One reader record, one or more detail (retiree) records, and one trailer record.
- Fixed length file/records.
- Fixed field lengths.
- Unless otherwise stated, all fields are defined as alpha numeric (Colbol PIC X) and left justified.
| Data element | Field description | Notes |
|---|---|---|
| Record Type | PIC X(01) | Value 'H' |
| Application Number | PIC X(10) | Number assigned to the application by RDS Secure Web Site. Includes leading zeroes as needed to completely fill field. |
| Creation date | PIC X(08) | Date file created. CCYYMMDD |
| Creation time | PIC X(06) | Time file created. HHMMSS |
| Filler | PIC X(175) | Spaces |
| Data element | Field description | Notes |
|---|---|---|
Record type |
PIC X(01) |
Value 'D' |
SSN |
PIC X(09) |
Social Security Number for the beneficiary you are seeking RDS subsidy. This field may contain spaces if the HICN was provided. If subsidy is being requested for the spouse or dependent of retiree, make sure the SSN provided is the spouse's or dependent's, not that of the retiree. |
HICN |
PIC X(12) |
Medicare Health Insurance Claim Number for the beneficiary for whom you are seeking RDS subsidy. This field may contain spaces if the SSN was provided. |
First name |
PIC X(30) |
Beneficiary's First Name. If RDS subsidy is being requested for the spouse or dependent of a retiree, make sure the First Name provided in this field is the spouse's or dependent's, not that of the retiree. |
Middle initial |
PIC X(01) |
Optional field. Beneficiary's Middle Initial. If RDS subsidy is being requested for a spouse or dependent of a retiree, make sure the Middle Initial provided in this field is the spouse's or dependent's, not that of the retiree. |
Last name |
PIC X(40) |
Beneficiary's Last Name. If RDS subsidy is being requested for a spouse or dependent of a retiree, make sure the Last Name provided in this field is the spouse's or dependent's, not that of the retiree. |
Date of birth |
PIC X(08) |
CCYYMMDD. If RDS subsidy is being requested for a spouse or dependent of a retiree, make sure the Date of Birth provided in this field is the spouse's or dependent's, not that of the retiree. |
Gender |
PIC X(01) |
Value '0' = gender unknown |
Coverage effective date |
PIC X(08) |
CCYYMMDD. The date the beneficiary's (retiree, spouse, or dependent) coverage under the Plan Sponsor's prescription drug benefit option begins. |
Coverage termination date |
PIC X(08) |
CCYYMMDD. The date the beneficiary's (retiree, spouse, or dependent) coverage under the Plan Sponsor's prescription drug benefit option ends. |
Unique benefit option identifier |
PIC X(20) |
Unique Benefit Option Identifier (UBOI) (e.g., group number) corresponding to the benefit under which you submitted this retiree for RDS subsidy. You MUST reference the UBOI in this field exactly as it was entered on the RDS application, including any leading or trailing zeroes, spaces, punctuation,etc. Please reference the Benefit Option(s) Summary page in the RDS Secure Web Site if you are unsure what should be entered in this field. |
Relationship to retiree |
PIC X(02) |
Value '01' = self |
Transaction type |
PIC X(03) |
Value 'ADD'– Retiree has either never been submitted for the corresponding RDS Application Number, or was submitted but never accepted for a subsidy period. |
| Data element | Field description | Notes |
|---|---|---|
Record Type |
PIC X(01) |
Value 'T' |
Application Number |
PIC X(10) |
Number assigned to the application by RDS Secure Web Site. Includes leading zeroes as needed to completely fill field. |
Creation date |
PIC X(08) |
Date file created. CCYYMMDD |
Creation time |
PIC X(06) |
Time file created. HHMMSS |
Number of detail records |
PIC X(07) |
Right justified and zero filled. |
Filler |
PIC X(168) |
Spaces |
When using Mainframe-to-Mainframe connection, may I transmit retiree information for more than one application in the same file?
Yes, you may transmit retiree information to the RDS Center for more than one application at the same time as long each retiree file has its own Header Record, Detail Record, and Trailer Record. See the example below for clarification.
Application 1596 Header Record Detail Record 1 Detail Record 2 Detail Record 3 Detail Record 4 Detail Record 5 Application 1596 Trailer Record Application 2486 Header Record Detail Record 1 Detail Record 2 Detail Record 3 Application 2486 Trailer Record Application 4935 Header Detail Record 1 Application 4935 Trailer Record
When using Mainframe-to-Mainframe connection, may multiple retiree files be sent for the same application from different sources?
Yes, multiple retiree files may be transmitted for the same application from different sources, but ONLY after you have submitted your valid initial retiree list and the RDS Center found at least one eligible retiree. In addition, your valid initial retiree list MAY ONLY be submitted by one source. However, after at least one retiree is found eligible, you may submit additional retirees in your monthly add/update/delete retiree file for the same application from different sources. Keep in mind that the method you used to submit your retiree file will also be the same method the RDS Center uses to send your retiree response files.
How will I know if my mainframe retiree file was rejected?
If your mainframe retiree file was rejected (did not pass the first level of edits because errors were found in the Header Record, Detail Record, and or Trailer Record), your technical contact will receive a phone call from the RDS Center. The RDS Center does not send a retiree response file back for a rejected retiree file that does not pass first level editing.
However, if your retiree file passes the first level of edits, but the RDS Center finds errors with particular data elements (invalid Application ID, Unique Benefit Option Identifier (UBOI), SSN or HICN, incorrectly formatted data elements, etc.) you will receive a retiree response file with reason codes. The RDS Center needs you to research the data element and corresponding reason code. It is important that the data elements provided in the retiree file, such as date of birth, gender, SSN or HICN, and UBOI are accurate. Note, the retiree file must reference the UBOI exactly as it is entered on the application. If the RDS Center cannot match the UBOI entered on the retiree file to any UBOI on the application, the entire retiree file will be rejected.
Therefore, if any data element is entered incorrectly, please correct and resubmit the retiree data in your next monthly add/update/delete retiree file. In the case of a subsidy period request for a retiree's dependent or spouse, the SSN should correspond with the individual for whom you are requesting a subsidy period, such as that of the dependent or spouse, not the retiree.
Where can I view the Retiree List Copybook?
View the Retiree List Copybook.
Retiree Response File from the RDS Center
This section addresses questions and the processes around Retiree Response Files, such as how to process your retiree response file, what various reason codes mean, what you should do if a retiree is rejected, and more.
- What is a retiree response file?
- How will I receive my retiree file if I submitted it via mainframe?
- How long should it take to receive my mainframe response file?
- How will I know if my initial retiree response file is available?
- What should I do when I receive my response file?
- When should I send my first monthly add/update/delete retiree file?
- What if the RDS Center rejects one of my retirees/beneficiaries and I do not agree with the decision?
- What if the retiree response file indicates that I do not have any valid retirees?
- What does it mean if a record in my response file has a reason code of 00?
- What do I do if I resubmitted a previously rejected retiree and the RDS Center rejects them for a second time?
- How is the RDS Center calculating RDS subsidy periods?
- What data is included in the retiree response file?
- What do I do if a retiree has a reason code 16 – Not a Valid Medicare Beneficiary?
- What do I do if I have a question about a specific retiree's response information sent from the RDS Center?
- Why do some of my retirees have a reason code 12 and their subsidy period termination date is the end of the month?
- What should I do if my retiree's enrollment changes?
- Where can I view the Retiree Response File Copybook?
What is a retiree response file?
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 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.
How will I receive my retiree response file if I submitted it via mainframe?
Assuming that you selected the Mainframe-to-Mainframe retiree file submission method on your application and have a successful mainframe connection to the RDS Center, you will receive your retiree response files back from the RDS Center via the mainframe. Keep in mind that the method you used to submit your retiree file will also be the same method the RDS Center uses to send your retiree response files.
How long should it take to receive my mainframe response file?
It takes the RDS Center approximately five to seven days to process the valid initial retiree list. It takes the RDS Center approximately three to five days to process monthly add/update/delete retiree files. Therefore, if more then seven days pass without receiving your retiree response file, contact the RDS Center for more information.
How will I know if my initial retiree response file is available?
Your initial retiree response file will be available after you receive an approval e-mail indicating your application was approved. Your response file should be posted on the RDS Secure Web Site approximately five to seven days after transmission.
What should I do when I receive my retiree response file?
When you receive a retiree response file, the RDS Center requests that you review and process the information in your retiree response files as soon as possible. If your response file comes back and a retiree record has a reason code,you must research the data elements in the retiree record with the corresponding reason code. Please make sure you use all the information available to you in the RDS Program Web Site about the reason code,and their specific interpretations when applying the response data back to your internal databases.
When should I send my first monthly add/update/delete retiree file?
The first monthly add/update/delete retiree file should be sent approximately 30 days from the date you receive and process the initial retiree response file. Response files must be processed by Plan Sponsors and subsidy periods posted in their internal systems so that the appropriate payment calculations may be performed.
What if the RDS Center rejects one of my retirees/beneficiaries and I do not agree with the decision?
If the RDS Center rejects one of your retirees, please verify that the retiree's information was entered correctly. If incorrect information was entered, please change the information accordingly and resubmit in the next monthly add/update/delete retiree file. If the retiree was denied for the subsidy all together, resubmit that record as an Add. If there was only a discrepancy in the subsidy periods resubmit the record as an Update.
If after verifying the retiree's information,you believe the determination made by the RDS Center is incorrect, please resubmit the retiree on the next monthly add/update/delete retiree file. The reason for the rejections could be that the retiree's information has been updated at the RDS Center or at MBD, causing the determination to be different then what you were expecting.
What if the retiree response file indicates that I do not have any valid retirees?
If your retiree response file indicates that you do not have any valid qualifying covered retirees, please verify that the information was entered correctly. In many cases, files with no valid qualifying covered retirees have an invalid Application ID, invalid Unique Benefit Option Identifier (UBOI), or some basic formatting problem. Note, the valid initial retiree file and monthly add/update/delete retiree files must reference the UBOI exactly as it is entered on the application. If the RDS Center cannot match the UBOI entered on the retiree file to any UBOI on the application, the entire retiree file will be rejected.
Therefore, if incorrect information was entered, please change the information accordingly and resubmit your retiree list. Check the reason codes associated with the denied records and trouble-shoot accordingly.
What does it mean if a record in my response file has a reason code of 00?
If a record has a reason code 00 and a determination indicator of "Y," the row has been accepted by the RDS Center. You will be eligible to receive a subsidy payment for the individual identified in that row.
If a record has a reason code 00 and determination indicator of "N," the subsidy period you requested for the retiree is outside the range of the plan year for the application, or the subsidy end date you requested is before 01/01/2006, the beginning of the RDS Program.
What do I do if I resubmitted a previously rejected retiree and the RDS Center rejects them for second time?
If after resubmitting a previously rejected retiree the RDS Center issues a second rejection, and you still do not feel that the decision is correct, please call the RDS Help Line and report the discrepancy. The RDS Center will research the determination(s) as necessary and advise you accordingly. As the RDS Center researches the discrepancy, the RDS Center recommends that you continue to resubmit the retiree(s) on monthly add/update/delete retiree files.
How is the RDS Center calculating RDS subsidy periods?
To process a retiree file, the RDS Center will query the Medicare Beneficiary Database (MBD) and determine if each individual is a qualifying covered retiree, eligible for the subsidy based on Medicare entitlement. The RDS Center will then determine the periods of time the retiree can be claimed for the subsidy during the plan year. Subsidy periods will be sent back in the retiree response file (see record layout below).
What data is included in the retiree response file?
The retiree response records will contain all the original fields (marked with an asterisk) sent by the Plan Sponsor in the retiree file record layout, plus the determination indicator, subsidy dates, and reason code. The Plan Sponsor may receive multiple responses (records) for a single beneficiary in the event that there is a gap in RDS Coverage Periods based on Medicare entitlement.
Please see the Retiree Response File Copybook for more information.
Note: Retiree response files must be processed by Plan Sponsors and subsidy periods posted in their internal systems so that the appropriate payment calculations may be performed.
| Data element | Field description | Notes |
|---|---|---|
| Record Type | PIC X(01) | Value 'H' |
| Application Number | PIC X(10) | Number assigned to the application by RDS Secure Web Site. Includes leading zeroes as needed to completely fill field. |
| Creation date | PIC X(08) | Date file created. CCYYMMDD |
| Creation time | PIC X(06) | Time file created. HHMMSS |
| Filler | PIC X(175) | Spaces |
| Data element | Field description | Notes |
|---|---|---|
Record type |
PIC X(01) |
Value 'D' |
SSN* |
PIC X(09) |
Social Security Number for the beneficiary you are seeking RDS subsidy. This field may contain spaces if the HICN was provided. If subsidy is being requested for the spouse or dependent of a retiree, make sure the SSN provided is the spouse's or dependent's, not that of the retiree. |
HICN * |
PIC X(12) |
Medicare Health Insurance Claim Number for the beneficiary for whom you are seeking RDS subsidy. This field may contain spaces if the SSN was provided. |
First name* |
PIC X(30) |
Beneficiary's First Name. If RDS subsidy is being requested for the spouse or dependent of a retiree, make sure the First Name provided in this field is the spouse's or dependent's, not that of the retiree. |
Middle initial* |
PIC X(01) |
Optional field. Beneficiary's Middle Initial. If RDS subsidy is being requested for a spouse or dependent of a retiree, make sure the Middle Initial provided in this field is the spouse's or dependent's, not that of the retiree. |
Last name* |
PIC X(40) |
Beneficiary's Last Name. If RDS subsidy is being requested for a spouse or dependent of a retiree, make sure the Last Name provided in this field is the spouse's or dependent's, not that of the retiree. |
Date of birth* |
PIC X(08) |
CCYYMMDD. If RDS subsidy is being requested for a spouse or dependent of a retiree, make sure the Date of Birth provided in this field is the spouse's or dependent's, not that of the retiree. |
Gender* |
PIC X(01) |
Value '0' = gender unknown |
Coverage effective date* |
PIC X(08) |
CCYYMMDD. The date the beneficiary's (retiree, spouse, or dependent) coverage under the Plan Sponsor's prescription drug benefit option begins. |
Coverage termination date* |
PIC X(08) |
CCYYMMDD. The date the beneficiary's (retiree, spouse, or dependent) coverage under the Plan Sponsor's prescription drug benefit option ends. |
Unique benefit option identifier |
PIC X(20) |
Unique Benefit Option Identifier (UBOI) (e.g., group number) corresponding to the benefit under which you submitted this retiree for RDS subsidy. You MUST reference the UBOI in this field exactly as it was entered on the RDS application, including any leading or trailing zeroes, spaces, punctuation,etc. Please reference the Benefit Option(s) Summary page in the RDS Secure Web Site if you are unsure what should be entered in this field. |
Relationship to retiree* |
PIC X(02) |
Value '01' = self |
Transaction type |
PIC X(03) |
Value 'ADD'– Retiree has either never been submitted for the corresponding RDS Application Number, or was submitted but never accepted for a subsidy period. |
| Determination Indicator | PIC X(01) | Y = Yes, the retiree qualifies for the RDS subsidy. N = No, the retiree does not qualify for the RDS subsidy. |
| Reason Code | PIC X(02) | See Reason Code list provided. |
| Subsidy Period Effective date | PIC X(08) | CCYYMMDD. The effective date of the beneficiary's RDS coverage. See Reason Code list for how these dates are filled in combination with specific scenarios. |
| Subsidy Period Termination date | PIC X(08) | CCYYMMDD. The termination date of the beneficiary's RDS coverage. See Reason Code list for how these dates are filled in combination with specific scenarios. |
| Filler | PIC X(38) | Spaces |
| Code | Description |
|---|---|
00 |
If a record has a Reason Code of 00 and a Determination Indicator of "Y", the row has been accepted by the RDS Center. |
01 |
Application did not meet filing deadline - The Plan Sponsor did not meet application deadline requirements as specified in 42 CFR §423.884(c). |
02 |
Invalid Application number - The Application ID in the record you sent is not a valid Application in the RDS System. Please ensure the Application ID is submitted EXACTLY as it appears in the RDS Secure Web Site. |
03 |
Invalid last name - Field Contains Spaces or is Numeric |
04 |
Invalid first name - Field Contains Spaces or is Numeric |
05 |
Invalid date of birth - Must be a valid date in CCYYMMDD format |
06 |
Invalid gender - Must be 0=gender unknown, 1=male, or 2=female |
07 |
Invalid coverage effective date - Must be a valid date in CCYYMMDD format |
08 |
Invalid coverage termination date – Must be a valid date in CCYYMMDD format |
09 |
Invalid unique benefit option identifier - You have submitted a retiree file with a UBOI that does not precisely reflect the UBOI on your application. |
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 he or 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 have applied. If the Determination Indicator is "Y" be sure to check the Subsidy Period Effective and End dates for the adjusted coverage. If this eligibility creates a gap in the coverage period you will receive more than one record for this beneficiary. If the Determination Indicator is "N," this beneficiary is not be eligible for RDS subsidy now or in the future. Disclaimer: Due to the sensitive nature of this information, the 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, the RDS Center is not at liberty to discuss specific entitlements with Plan Sponsors. Click here for more information about reason code 12. |
13 |
Invalid HICN or SSN - The Social Security Number must be numeric, all zeros, or all nines. The HICN must be non-numeric. |
14 |
Termination date is less than effective date – The Coverage Termination Date you sent for this beneficiary is earlier than the Coverage Effective Date. |
16 |
Not a valid Medicare Beneficiary – This beneficiary was not found in the Medicare Beneficiary Database. Click here for more information about reason code 16. |
17 |
No coverage period exists for delete transaction.The RDS Center has made no update. |
18 |
Invalid action type – Must be ADD, DEL, or UPD |
19 |
Invalid relationship code – Must be 01 = self, 02 = spouse, or 03 = other |
| Data element | Field description | Notes |
|---|---|---|
Record Type |
PIC X(01) |
Value 'T' |
Application Number |
PIC X(10) |
Number assigned to the application by RDS Secure Web Site. Includes leading zeroes as needed to completely fill field. |
Creation date |
PIC X(08) |
Date file created. CCYYMMDD |
Creation time |
PIC X(06) |
Time file created. HHMMSS |
Number of detail records |
PIC X(07) |
Right justified and zero filled. |
Filler |
PIC X(168) |
Spaces |
What do I do if a retiree has a reason code 16 – Not a Valid Medicare Beneficiary?
If a retiree has a reason code 16 – not a valid Medicare Beneficiary, you must research the data elements submitted to the RDS Center for that individual retiree. Please research the data elements provided in the retiree file, such as date of birth, gender, and SSN or HICN, to ensure the information provided is accurate. If any data element is entered incorrectly, please correct and resubmit the retiree data in your next monthly add/update/delete retiree file. In the case of a subsidy period request for a retiree's dependent or spouse the SSN should correspond with the individual for whom you are requesting a subsidy period, such as that of the dependent or spouse, not the retiree.
What do I do if I have a question about specific retiree's response information sent from the RDS Center?
If you have a question about the retiree response information returned from the RDS Center, and you believe the information you submitted is correct, please resend the information in your next monthly add/update/delete retiree file. If the retiree was originally denied to be claimed for the subsidy, send the retiree in your next monthly retiree file as an add. If the retiree was accepted to be claimed for the subsidy, but not for the date ranges you originally intended, send the retiree in your next monthly retiree file as an update.
If after resubmitting a previously rejected retiree the RDS Center issues a second rejection, and you still does not feel that the decision is correct, please call the RDS Help Line and report the discrepancy. The RDS Center will research the determination(s) as necessary and advise you accordingly. As the RDS Center researches the discrepancy, the RDS Center recommends that you continue to resubmit the retiree(s) on monthly add/update/delete retiree files.
Why do some of my 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, and 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.
What should I do if my retiree's enrollment changes?
When the beneficiary's coverage ends prior to the coverage begin date you previously reported, you should send a delete record to the RDS Center. The delete record coverage dates should match those you previously submitted. This rule applies if you want to switch them from one benefit option to the other as well, effectively replacing the previous coverage. (The RDS Center's database will match the coverage records on beneficiary (internal ID), application, unique benefit option, and coverage start date.)
Where can I view the Retiree Response File Copybook?
View the Retiree Response File Copybook.
Weekly Notification File from the RDS Center
This section addresses questions and the processes around Weekly Notification Files such as how to process your Weekly Notification File, what various reason codes mean, what if there are no Weekly Notification Files, and more.
- If my retiree file submission method is Mainframe-to-Mainframe, how will I receive my notification files?
- When should I expect to receive my weekly notification file?
- What if there are no weekly notification files?
- How will I know when the weekly notification files are available for download?
- What data is being sent in the weekly notification file?
- 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?
If my retiree file submission method is Mainframe-to-Mainframe, how will I receive my notification files?
Assuming that you selected the Mainframe-to-Mainframe retiree file submission method on your application and have a successful mainframe connection to the RDS Center, you will receive your weekly notification file via the mainframe.
Since the RDS Center uses the current retiree submission method to determine which file transfer method to use to send the weekly notification file to the Plan Sponsor, if you select Mainframe-to-Mainframe before the connection is successfully established, the RDS Center will be unable to send the weekly notification file to the Plan Sponsor until the Mainframe-to-Mainframe is established, or until the retiree file submission method is changed back to File Upload. Additionally, if you changed your Retiree Submission Method to Mainframe-to-Mainframe or switched Vendors, once your new connection is established you are required to submit anew valid initial retiree list to the RDS Center using the new submission method because each retiree must be associated with a Vendor or a Plan Sponsor in order to receive weekly notification files.
When should I expect to receive my weekly notification files?
You should expect to receive a weekly notification file once a week, on Fridays. If you do not receive a weekly notification file it could be because none of the beneficiaries covered under that application had notification events for that week. 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.
What if there are no weekly notification files?
If you do not receive a Weekly Notification File it could be because none of the beneficiaries covered under that application 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.
Since your retiree file submission method is Mainframe-to-Mainframe, 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, and in this case it is Mainframe-to-Mainframe.
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.
What data is being sent in the weekly notification file?
When 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. Weekly 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. 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.
The weekly notification files will contain all the original data elements that you sent in your retiree file layout, plus the determination indicator, reason codes, subsidy period effective date, and the subsidy period termination date as described below. However, the "transaction type" data element will be left blank.
| Data element | Field description | Notes |
|---|---|---|
Record Type |
PIC X(01) |
Value 'H' |
Application Number |
PIC X(10) |
Number assigned to the application by RDS Secure Web Site. Includes leading zeroes as needed to completely fill field. |
Creation date |
PIC X(08) |
Date file created. CCYYMMDD |
Creation time |
PIC X(06) |
Time file created. HHMMSS |
Filler |
PIC X(175) |
Spaces |
| Data element | Field description | Notes |
|---|---|---|
Record type |
PIC X(01) |
Value 'D' |
SSN* |
PIC X(09) |
Social Security Number for the beneficiary you are seeking RDS subsidy. This field may contain spaces if the HICN was provided. If subsidy is being requested for the spouse or dependent of a retiree, make sure the SSN provided is the spouse's or dependent's, not that of the retiree. |
HICN * |
PIC X(12) |
Medicare Health Insurance Claim Number for the beneficiary for whom you are seeking RDS subsidy. This field may contain spaces if the SSN was provided. |
First name* |
PIC X(30) |
Beneficiary's First Name. If RDS subsidy is being requested for the spouse or dependent of a retiree, make sure the First Name provided in this field is the spouse's or dependent's, not that of the retiree. |
Middle initial* |
PIC X(01) |
Optional field. Beneficiary's Middle Initial. If RDS subsidy is being requested for a spouse or dependent of a retiree, make sure the Middle Initial provided in this field is the spouse's or dependent's, not that of the retiree. |
Last name* |
PIC X(40) |
Beneficiary's Last Name. If RDS subsidy is being requested for a spouse or dependent of a retiree, make sure the Last Name provided in this field is the spouse's or dependent's, not that of the retiree. |
Date of birth* |
PIC X(08) |
CCYYMMDD. If RDS subsidy is being requested for a spouse or dependent of a retiree, make sure the Date of Birth provided in this field is the spouse's or dependent's, not that of the retiree. |
Gender* |
PIC X(01) |
Value '0' = gender unknown |
Coverage effective date* |
PIC X(08) |
CCYYMMDD. The date the beneficiary's (retiree, spouse, or dependent) coverage under the Plan Sponsor's prescription drug benefit option begins. |
Coverage termination date* |
PIC X(08) |
CCYYMMDD. The date the beneficiary's (retiree, spouse, or dependent) coverage under the Plan Sponsor's prescription drug benefit option ends. |
Unique benefit option identifier |
PIC X(20) |
Unique Benefit Option Identifier (UBOI) (e.g., group number) corresponding to the benefit under which you submitted this retiree for RDS subsidy. You MUST reference the UBOI in this field exactly as it was entered on the RDS application, including any leading or trailing zeroes, spaces, punctuation,etc. Please reference the Benefit Option(s) Summary page in the RDS Secure Web Site if you are unsure what should be entered in this field. |
Relationship to retiree* |
PIC X(02) |
Value '01' = self |
Transaction type |
PIC X(03) |
Blank- Only applicable for weekly notification files. |
Determination Indicator |
PIC X(01) |
Y = Yes, the retiree qualifies for an RDS subsidy period |
Reason Code |
PIC X(02) |
See Reason Code list provided. |
Subsidy Period Effective date |
PIC X(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 |
PIC X(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 – if you get this code and a Determination Indicator N, the Beneficiary is enrolled in Medicare Part D for the entire RDS coverage period, for which you were previously approved for subsidy. If you get this code and a Determination Indicator Y the Beneficiary has enrolled in Medicare Part D and your RDS coverage period, for the beneficiary, is shortened. You should expect to find a new RDS Termination Date. Replace all RDS coverage in this situation. Disclaimer: Due to the sensitive nature of this information, the 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 N 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, the 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, the RDS Center is not at liberty to discuss specific entitlements with Plan Sponsors. Click here for more information about reason code 12. |
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 date swill be set to zero. The previously approved subsidy will not change. Click here for more information about reason code 20. |
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 file. Click here for more information about reason code 21. |
| Data element | Field description | Notes |
|---|---|---|
Record Type |
PIC X(01) |
Value 'T' |
Application Number |
PIC X(10) |
Number assigned to the application by RDS Secure Web Site. Includes leading zeroes as needed to completely fill field. |
Creation date |
PIC X(08) |
Date file created. CCYYMMDD |
Creation time |
PIC X(06) |
Time file created. HHMMSS |
Number of detail records |
PIC X(07) |
Right justified and zero filled. |
Filler |
PIC X(168) |
Spaces |
Note: The 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.
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: reason code 10 – Enrolled in Medicare Part D, reason code 11 – Not eligible for Medicare, or reason code 12 – Beneficiary is Dead 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: reason code 10 – Enrolled in Medicare Part D, reason code 11 – Not eligible for Medicare, or reason code 12 – Beneficiary is Dead 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 Sponsor's plan. For the Sponsor, a beneficiary's enrollment in 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 that retiree in the next monthly add/update/delete retiree file as an add. With reason code 21 in a notification file, the RDS Center will never send increased coverage period.
Why do some of my 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 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.
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