How To Complete Step 3: Request List of Covered Retirees - New 05/10/2007
The following document refers to reconciliation and provides questions and answers regarding Step 3. This section contains information about who may complete the step, when and how the step should be completed and other information related to reconciliation. This document includes information about the following:
- What is the purpose of Step 3: Request List of Covered Retirees?
- When can Plan Sponsors begin Step 3: Request List of Covered Retirees?
- Who is allowed to complete Step 3: Request List of Covered Retirees?
- Who can download the covered retiree list?
- How can I tell if Step 3: Request List of Covered Retirees has been completed?
- Can Step 3: Request List of Covered Retirees be undone after it is completed?
- What happens after Step 3: Request List of Covered Retirees is completed?
- Can a covered retiree list be requested more than once?
- From where can the covered retiree list be downloaded?
- What is the format of the covered retiree list?
- What is included in the covered retiree list?
- When can the covered retiree list be downloaded?
- What if I do not agree with the covered retiree list?
- What is the importance of the covered retiree list's correctness?
- Can retirees or subsidy date ranges not on the covered retiree list be submitted for subsidy payment?
- How does a Plan Sponsor complete Step 3: Request List of Covered Retirees?
What is the purpose of Step 3: Request List of Covered Retirees?
The purpose of this step is for the Plan Sponsor to request a covered retiree list. The list will include a record(s) for each qualifying covered retiree for each benefit option for each subsidy period that has been approved by CMS' RDS Center. This list must be finalized by the Authorized Representative or Account Manager in Step 4 so the Plan Sponsor should assign appropriate staff to review and validate the list. This is important because the retiree counts used in the validation of the final costs are based on this covered retiree list.
When can Plan Sponsors begin Step 3: Request List of Covered Retirees?
Step 3 cannot be started until Step 1 through Step 2 have been completed. Step 3 must be marked "Complete" on the Reconciliation Checklist to proceed to the remaining steps. Please keep in mind the retiree list may be requested multiple times by Plan Sponsors before completing Step 4, but may only be requested once per day.
Who is allowed to complete Step 3: Request List of Covered Retirees?
Step 3 can only be completed by the Account Manager, Authorized Representative, or Designees with the Request Payment privilege.
Who can download the covered retiree list?
The covered retiree list can be downloaded by the Authorized Representative and the Account Manager. Designees with the Retiree Data privilege may access the Download Covered Retiree List page using the Manage Retirees page. Designees must have both the Retiree Data privilege and the Request Payment privilege to access the Download Covered Retiree List page using the direct link from Step 3 and Step 4 of the Reconciliation Checklist.
How can I tell if Step 3: Request List of Covered Retirees has been completed?
The Reconciliation Checklist displays as follows:
- Step 3 is marked with a green check to indicate that the step is complete after the first retiree list is requested and Step 4 is marked with a blue arrow to indicate that it is the next step.
- The status of Step 3 will be marked "Complete" on the Reconciliation Checklist.
- The Last Updated Date and Last Updated By fields are updated accordingly.
- The status of the application will remain "Reconciliation Initiated."
Can Step 3: Request List of Covered Retirees be undone after it is completed?
No. Although Step 3 is marked "Complete" after the first list is requested, a covered retiree list may be requested daily, as necessary, until Step 4 is completed.
What happens after Step 3: Request List of Covered Retirees is completed?
After Step 3 has been completed the covered retiree list is generated by CMS' RDS Center. The status of the application will remain "Reconciliation Initiated." The covered retiree list will be created by CMS' RDS Center on a nightly basis and will be available for download using the Manage Retirees page within two business days after the request.
Can a covered retiree list be requested more than once?
Yes. A covered retiree list may be requested multiple times until Step 4 has been completed. However, only one retiree list may be requested per day.
From where can the covered retiree list be downloaded?
The covered retiree list may be downloaded from the Download Covered Retiree List page which may be accessed from the Manage Retirees page on the RDS Secure Web Site. The Download Covered Retiree List page may also be accessed using a direct link from Step 3 and Step 4 of the Reconciliation Checklist. For more information about how to download the covered retiree list, go to: How To Download Covered Retiree List.
What is the format of the covered retiree list?
The covered retiree list will be in Comma Separated Value (CSV) format. The CSV file is also referred to as a "flat file" or "comma delimited file." Computer systems use this type of file to pass information back and forth between databases. Each line represents one entry or record and a comma separates each data element within a record. A separate record is created for each unique beneficiary, benefit option and subsidy period combination. Each record will include the following data elements:
| Data element | Max size | Notes |
|---|---|---|
| Application ID | 10 | RDS application number under which the retiree was approved for subsidy. |
| SSN* | 09 | Social Security Number for the beneficiary that was approved for RDS. This field may be blank if the HICN was provided instead during retiree list submission. |
| HICN* | 12 | Medicare Health Insurance Claim Number for the beneficiary that was approved for RDS. This field may contain spaces if the SSN was provided instead during retiree list submission. |
| First name* | 30 | Beneficiary's First Name. |
| Middle initial* | 01 | Optional field. Beneficiary's Middle Initial. |
| Last name* | 40 | Beneficiary's Last Name. |
| Date of birth* | 08 | CCYYMMDD. |
| Gender* | 01 | 0=gender unknown, 1=male, 2=female. |
| Effective date* | 08 | CCYYMMDD.The beginning date the beneficiary's (retiree, spouse, or dependent) coverage under this prescription drug benefit option. |
| Termination date* | 08 | CCYYMMDD.The ending date the beneficiary's (retiree, spouse, or dependent) coverage under this prescription drug benefit option. |
| Unique Benefit Option Identifier (UBOI) | 20 | The unique identifier assigned to this prescription drug benefit option. |
| Relationship to retiree* | 02 | 01=self, 02=spouse, or 03=other |
| Type of Record* | 03 | ADD or UPD. Will be equal to the last record type submitted for this beneficiary in a retiree file. |
| Determination Indicator | 01 | Y = Yes. All records in the Covered Retiree File are approved for subsidy. |
| Reason code | 02 | See Reason Code List Below. |
| Subsidy Period Effective Date | 08 | CCYYMMDD. The effective date of the beneficiary's (retiree, spouse, or dependent) RDS coverage. |
| Subsidy Period Termination Date | 08 | CCYYMMDD. The termination date of the beneficiary's (retiree, spouse, or dependent) RDS coverage. |
| Submitter Type | 01 | P=Plan Sponsor, V=Vendor, C=VDSA/COB |
| Submitter Name | 50 | Plan Sponsor, Vendor, or COB Contractor name |
Note: All of the data elements noted with an asterisk (*) will contain the latest information provided by the Plan Sponsor in a retiree list.
| 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 previously applied. If this eligibility creates a gap in the coverage period you will receive more than one record for this beneficiary. Refer to the Subsidy Period Effective date and Subsidy Period Termination Date for the period that you may claim the beneficiary for the subsidy. 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 some portion the period of RDS coverage for which you previously applied. If this eligibility creates a gap in the coverage period you will receive more than one record for this beneficiary. Refer to the Subsidy Period Effective date and Subsidy Period Termination Date for the period that you may claim the beneficiary for the 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 previously applied.The beneficiary's death has been reported to CMS' RDS Center by MBD. Refer to the Subsidy Period Effective date and Subsidy Period Termination Date for the period that you may claim the beneficiary for the subsidy. Disclaimer: Due to the sensitive nature of this information, CMS' RDS Center is not at liberty to discuss specific entitlements with Plan Sponsors. |
What is included in the covered retiree list?
This list includes the same fields currently required in RDS covered retiree reporting plus two additional fields that will give reporting source information for the convenience of the Plan Sponsor. The covered retiree list includes all beneficiaries having at least one benefit option where at least one subsidy period exists. A separate record is created for each unique beneficiary, benefit option and subsidy period combination. Any retiree records that were submitted to and rejected by CMS' RDS Center will not be reflected in this list. For a list of data elements, go to: What is the format of the covered retiree list?
When can the covered retiree list be downloaded?
The covered retiree list should be available within two business days from the time of the request.
What if I do not agree with the covered retiree list?
If a retiree record that was expected to be on this list is absent, or if any of the subsidy periods do not match the Plan Sponsor's internal records, the Plan Sponsor should begin by ensuring that they have processed all of the retiree response and weekly notification files for this application. After all files have been processed the Plan Sponsor should compare their updated internal records to the covered retiree list.
Submit an ADD/UPD/DEL retiree file containing records for the beneficiaries in question when the following occurs:
- The Plan Sponsor's internal records still indicate that the beneficiaries not appearing on the covered retiree list have approved subsidy periods under this application.
- The Plan Sponsor's internal records still indicate that the beneficiaries have different approved subsidy periods under this application.
- The Plan Sponsor is unable to process the retiree response and weekly notification files for any reason.
OR
OR
If the above actions do not resolve the discrepancies the Plan Sponsor should work with the beneficiary to validate all identifying information (e.g. Date of Birth, HICN, or SSN) and Medicare coverage. The beneficiary may contact 1-800-Medicare to discuss any identifying information or coverage issues. If the Plan Sponsor is still unable to resolve the discrepancy, contact the RDS Help Line for assistance.
To learn more about working with retiree files and notification files go to: How To Manage Retiree Files.
What is the importance of the covered retiree list's correctness?
Federal law requires that cost data be submitted only for the individual beneficiaries, benefit options, and subsidy periods listed in the covered retiree list.
Can retirees or subsidy date ranges not on the covered retiree list be submitted for subsidy payment?
No. Cost data can only be submitted for the specific retirees and subsidy periods included in the covered retiree list.
How does a Plan Sponsor complete Step 3: Request List of Covered Retirees?
- Log into the RDS Secure Web Site.
- The Plan Sponsor List With Application Summary page displays.
- Select the appropriate Plan Sponsor ID link. The Application List page displays.
- From the Application List page, find the Application Number to reconcile. To access reconciliation, select Reconciliation from the Actions dropdown and select Go.
- The Reconciliation Checklist page displays. Select Step 3: Request List of Covered Retirees.
- The Step 3: Request List of Covered Retirees page displays. To request a covered retiree list, select Request Covered Retiree List.
- The Reconciliation Checklist displays. The status of Step 3: Request List of Covered Retirees changes to "Complete" after the first covered retiree list is requested. The Last Updated Date and Last Updated By fields are updated accordingly. Step 3 is marked with a green check to indicate that it is complete and Step 4 is marked with a blue arrow to indicate that it is the next step.
