How To Submit Interim Cost Data - Updated 03/25/2008
This document provides information regarding how to submit interim cost data to CMS' RDS Center for interim payment requests. This information will help in understanding the interim cost data submission process so that costs can be reported to CMS' RDS Center accurately and proficiently, using the mainframe or data entry reporting method in the RDS Secure Web Site.
The primary audience for this document is Account Managers and Designees with the Report Costs privilege as defined in the Payment Setup menu. Authorized Representatives automatically have the Request Payment privilege and therefore cannot report costs. However, Authorized Representatives will have the ability to view interim cost reports for all benefit options, as discussed below.
Note: This document only provides information related to the process of submitting interim cost data to CMS' RDS Center. For information about how to prepare interim cost data, including the data elements required for submission, go to: How To Prepare Cost Data. For information about how to submit final cost data, go to: How to Submit Final Cost Data.
- What applications are eligible for interim cost report submissions?
- Where can Plan Sponsors learn more about reporting final costs during reconciliation?
- Who is eligible to participate in the cost submission process when using the data entry reporting method on the RDS Secure Web Site?
- Who is eligible to participate in the cost submission process when using the mainframe to mainframe reporting method?
- Is there a limit to the number of interim cost reports that may be submitted?
- Do I have to submit interim cost reports in any particular order?
- Once a Cost Reporter submits a cost report, are there limitations to what can be changed in Payment Setup?
- How may I submit costs to CMS' RDS Center?
- What do I need to do to change cost data that was previously submitted?
- What information is needed about cost file formats when using the mainframe submission method?
- How will I know if CMS' RDS Center received my mainframe cost report and was able to process it?
- May a Vendor mainframe cost file include more than one Plan Sponsor ID, Application ID, and/or months of cost data for the same Unique Benefit Option ID (UBOI)?
- What do I need to know if submitting costs using data entry on the RDS Secure Web Site?
- Will I receive a response file to my interim cost report?
- How do I enter estimated premiums using data entry on the RDS Secure Web Site?
- How do I enter gross eligible costs using data entry on the RDS Secure Web Site?
- How do I submit cost reports entered using data entry on the RDS Secure Web Site?
- How do I report adjusted costs for a month already submitted?
- How do I view reported cost data?
- How do I view submitted interim cost reports?
What applications are eligible for interim cost report submissions?
Interim cost reports may only be accepted on applications that meet the following conditions:
- Application must be in an "Approved" or "Approved Appeal" status.
- Payment Setup must be complete for the application (Step 6 of the Payment Setup menu must have a status of "Complete").
- The payment frequency associated with the application must be monthly, quarterly, or interim annual. Note: Plan Sponsors with an annual payment frequency may only submit final costs during reconciliation. The payment frequency selected and submitted on the application is in effect for the duration of the Sponsor's plan year and cannot be changed.
Where can Plan Sponsors learn more about reporting final costs during reconciliation?
For more information about final cost reporting, go to: How to Submit Final Cost Data.
Who is eligible to participate in the cost submission process when using the Data Entry reporting method on the RDS Secure Web Site?
Account Managers, Plan Sponsor Designees, and Vendor Designees may enter costs using the data entry method for those benefit options for which they have been assigned the Report Costs privilege. Authorized Representatives cannot submit costs since the Authorized Representative is automatically assigned the Request Payment privilege for the application.
Who is eligible to participate in the cost submission process when using the mainframe to mainframe reporting method?
Anyone who has contacted CMS' RDS Center and followed the appropriate instructions to report costs using mainframe. For detailed information on how to report costs using the mainframe, go to: What information is needed about cost file formats when using the mainframe submission method?
Is there a limit to the number of interim cost reports that may be submitted?
No. There is no limit to the number of interim cost reports that may be supplied by a Cost Reporter. This flexibility is granted in order to ensure Plan Sponsors can always accurately report costs.
Do I have to submit interim cost reports in any particular order?
No. Reporting months may be supplied in any order as long as the Plan Sponsor is not reporting costs for a month that has not yet occurred (i.e. you cannot report costs for August if it is currently July.) Also, if reporting multiple Application IDs or benefit options using the mainframe, the cost reports do not have to be combined by Application ID or benefit option, as long as the reporting month is prior to the current month.
Once a Cost Reporter submits a cost report, are there limitations to what can be changed in Payment Setup?
Yes. The following actions will be prevented in Payment Setup once the Cost Reporter has submitted a cost report.
- Change Account Manager privilege from Report Costs to View Only or Request Payment
- Change Plan Sponsor Designee privilege from Report Costs to Request Payment
- Remove Vendor
- Remove benefit options from Cost Reporters (Vendor or Plan Sponsor)
How may I submit costs to CMS' RDS Center?
Cost reports may be submitted to CMS' RDS Center by two methods: mainframe transmission or data entry on the RDS Secure Web Site. Vendors will specify their cost reporting methods when registering with CMS' RDS Center. All Vendors must call CMS' RDS Center to obtain a Vendor ID regardless of whether they are submitting using mainframe, or data entry on the RDS Secure Web Site.
The Account Manager or Authorized Representative during Payment Setup will specify the reporting method for Cost Reporters not associated with Vendors. Any cost report that is submitted using a submission method other than the submission method indicated in the Payment Setup menu will be rejected. For more information about Payment Setup, go to: How to Complete Payment Setup.
What do I need to do to change cost data that was previously submitted?
Cost Reporters are required to re-supply the total cost data aggregated for a month when previously reported cost data for that month are adjusted or an erroneous report is detected by the Vendor or Plan Sponsor. Cost Reporters supplying cost data using data entry may report corrected cost data for a month by replacing previously reported cost data and resubmitting the cost report on the RDS Secure Web Site.
For detailed information on how to enter adjusted cost data in the RDS Secure Web Site for reported costs that either have or have not been included in a payment request, go to: How to Prepare Cost Data.
Those Cost Reporters using mainframe file submission may include corrected cost data for prior months in the same file as new cost reports or provide separate files for corrected cost data. If multiple files are sent, the last error-free record for the month will be retained as the most recent cost data for the month on the RDS Secure Web Site.
What information is needed about cost file formats when using the mainframe submission method?
Both Vendors and Plan Sponsors can send mainframe cost files. A Vendor file may contain cost reports for multiple Plan Sponsors, applications, and benefit options. A mainframe file reported by a Plan Sponsor may contain cost reports for multiple applications and benefit options, but only for a single Plan Sponsor. Both Vendor and Plan Sponsor files may report multiple months of cost data for a single benefit option and may include multiple benefit options and applications as well.
When a cost report is received using the mainframe, the data cannot be modified on the RDS Secure Web Site. An audit trail of all cost reports "accepted" by the mainframe will be viewable on the RDS Secure Web Site by benefit option.
The overall mainframe cost report file format is as follows:
File organization – Sequential
Record Format (RECFM) – Fixed (F) or Fixed Blocked (FB)
Record Length (LRECL) - 110 bytes
Block Size (BLKSIZE) - Determined by the sender's system
Note: FHDR information, File Creation Time must be preceded by leading zeros if time is less than 8 bytes (to prevent time as "8:11:11")
View detailed mainframe cost report file information.
View the mainframe copybook.
View a sample mainframe cost file.
Note: Before transmitting production cost data to CMS' RDS Center using mainframe; please contact the RDS Help Line for information on how to send test cost files to ensure proper connectivity is established.
How will I know if CMS' RDS Center received my mainframe cost report and was able to process it?
If the mainframe cost report was received and did not have any errors, it will display in the RDS Secure Web Site on the Benefit Option Interim Cost Summary page, 24-48 hours after it was transmitted.
If the mainframe file was received, and there were critical errors that prevented CMS' RDS Center from processing it, a RDS Electronic Data Interchange (EDI) Representative will contact the submitter to discuss the errors. There will be no record of the mainframe file submission in the RDS Secure Web Site. The following error conditions are considered critical, and will prevent the cost file from displaying in the RDS Secure Web Site:
- The Vendor ID is not found in the RDS database
- The Plan Sponsor ID is not found in the RDS database
- A field has an invalid format
- Negative numbers reported in any field
- The file format is invalid
- Trailer totals (Application and File) do not match the sum of the detail records
- The created date and time are earlier than the last processed date and time
- The Application ID is not found in the RDS database
- The Application ID is not associated with the Plan Sponsor
- The Unique Benefit Option Identifier (UBOI) is not associated with the application
A cost file with any of the above-mentioned error conditions must be corrected and resubmitted to the RDS Center.
If the mainframe file was received but there were non-critical errors, then specific information about the file and the corresponding errors can be viewed on the Audit Trail page. For more information on how to view a mainframe - submitted benefit option cost report, go to: How do I view reported cost data?
The following error conditions are considered non-critical but will prevent the cost file from being accepted for inclusion in a payment request. These error conditions must be corrected and the cost file must be resubmitted:
- Payment Setup is not complete for the application (be aware that CMS' RDS Center processes cost reports at midnight on the day they were submitted. Therefore, if the cost report is submitted at 2:00 pm and then Payment Setup is changed at 6:30 pm, and the status is "Incomplete", the cost report will not be processed.)
- The Vendor or Plan Sponsor's reporting method specified in Payment Setup is data entry
- The month/year reported falls outside of the application plan year
- Costs are supplied for a future month
- Estimated percentages of premiums are provided for self-insured benefit options
- The last available interim payment request was made for the application and not cancelled. If interim annual, one payment request is allowed. If monthly, twelve payment requests are allowed. If quarterly, four payment requests are allowed. Note: One-time payment counts toward the maximum number of payment requests
- The estimated cost adjustment is reported for a month prior to January 2006
- Costs are greater than zero and an eligible retiree does not exist for the UBOI with coverage effective dates that fall within the plan year. Note: Zero cost data will be accepted for a UBOI without an eligible retiree
The following error conditions will prevent the cost file from being accepted as an error-free cost file for inclusion in a payment request. Interim cost files with the following error conditions may not be viewed in the audit trail:
- The Vendor is not currently listed as a Cost Reporter on the application
- The Vendor is not currently a Cost Reporter for the UBOI
A cost file with any of the above-mentioned error conditions will need to be corrected and resubmitted to the RDS Center.
May a Vendor mainframe cost file include more than one Plan Sponsor ID, Application ID, and/or months of cost data for the same Unique Benefit Option ID (UBOI)?
Yes. A single mainframe file received from a Vendor may include data for multiple Plan Sponsor IDs (files from Plan Sponsors may only include one Plan Sponsor ID). Additionally, you may submit more than one Application ID in the same file, but they must be separated by an Application Trailer and start with another Application Header. Finally, you may submit multiple months of cost data for the same Unique Benefit Option Identifier (UBOI), but they must be separate detail lines. Files may contain multiple months of newly reported and/or corrected costs.
What do I need to know if submitting costs using data entry on the RDS Secure Web Site?
Cost Reporters with a data entry reporting method may enter interim cost reports directly on the RDS Secure Web Site. These Cost Reporters will be required to select an application and benefit option prior to entering cost data. Additionally, an audit trail of all cost reports either saved or submitted on the RDS Secure Web Site will be viewable by benefit option.
Note: The Authorized Representative does not need to be verified for interim cost reports to be accepted. For more information, go to: How To Submit an Authorized Representative Verification Form.
Will I receive a response file to my interim cost report?
No. CMS' RDS Center will not be sending response files when cost reports are received. For cost reports submitted using data entry in the RDS Secure Web Site, all submitted cost data is accepted and displayed in the RDS Secure Web Site. A response file is not necessary because the data will be accepted and displayed as entered. For more information on when the cost reports submitted using mainframe display on the RDS Secure Web Site, go to: How will I know if CMS' RDS Center received my mainframe cost report and was able to process it?
How do I enter estimated premiums using data entry on the RDS Secure Web Site?
If estimated premiums are reported instead of gross retiree costs, it must be consistently reported that way for the entire plan year. All reporting sources (Vendor/Plan Sponsor) for the benefit option also must consistently report that way for the entire plan year. Estimated premiums may only be reported on fully insured plans. For detailed information on how to prepare cost data using the estimated premium approach, go to: How To Prepare Cost Data.
Note: If the estimated premium cost amount does not include the estimated cost adjustment, then that sum must be reported separately in the estimated cost adjustment column.
- Log into the RDS Secure Web Site.
Note: If additional information is needed on field definitions or edits, click on the Help About This Page hyperlink in the Quick Help box on the top right hand corner of the page at any time during this step-by-step process.
- From the Plan Sponsor List With Application Summary page, select the Plan Sponsor ID for which you want to report costs.
- On the Application List page, find the appropriate Application Number. Select the Interim Costs option in the Actions dropdown list.
Note: The Interim Costs action will only display in the Actions column for Account Managers and Designees assigned the Report Costs privilege during Payment Setup. Designees with the Request Payment privilege will not have access to this page. Designees with the Request Payment privilege for the application will only have View Only access to all reported costs from the Payment Request and Audit Trail pages.
Additionally, this action will not display unless the application is approved, Payment Setup is complete, and the application payment frequency is monthly, quarterly, or interim annual.
- Select Go. The Interim Cost Benefit Option List page displays.
This page provides a list of benefit options for which the user has been authorized to enter and/or view interim cost data.
By default, the table is sorted in alphabetical order by Benefit Option Name. To sort the table by a different column, click on the column header link. The column selected will sort in ascending or descending order; an up (ascending) arrow or down (descending) arrow will display at the top of the column. To reverse the order, click the column header link again.
- On the Interim Cost Benefit Option List page, find the appropriate benefit option for which you would like to enter cost data. From the Actions dropdown list, select the Enter/Update Costs option and select Go. The Benefit Option Interim Cost Data Entry View page displays.
Note: The Enter/Update Costs option is only available if the Account Manager, Plan Sponsor Designee, or Vendor Designee has been assigned the Report Costs privilege with a "Data Entry" method, and the last allowable interim payment request has not been made for the application.
The Benefit Option Interim Cost Data Entry View page contains cost figures saved to the RDS Secure Web Site. Data can be added and edited from this page.
- Find the Month/Year for which costs should be entered and click the edit link. Only one month/year can be edited at a time.
The Benefit Option Interim Cost Data Entry Edit page displays.
This page allows the entry of the aggregated estimated premium amount per month. If the estimated premium cost amount does not include the estimated cost adjustment, that sum must be reported separately in the estimated cost adjustment column.
- To enter estimated premium for the selected month, provide aggregated retiree data in the following field: Estimated Premium. If applicable, to enter estimated cost adjustments for the selected month, provide the amount in the following field: Estimated Cost Adjustment.
Estimated Premium Cost – This column may only be reported by fully insured unique benefit options. It is the portion of premium costs (excluding administrative costs, risk charges, etc.) paid by the Plan Sponsor and by the qualifying covered retiree that, based on a determination by the insurer using reasonable actuarial principles, is allocated to gross retiree costs between the cost threshold and the cost limit.
Estimated Cost Adjustment – Estimate of the expected rebates and other price concessions (discounts, charge-backs, etc.) attributable to the gross retiree costs during the year between the cost threshold and the cost limit. Estimated cost adjustments will not be accepted for months in 2005.
- After cost data is entered into the appropriate fields, select Save. Select Cancel to return to the Benefit Option Interim Cost Data Entry View page without saving changes.
On the Benefit Option Interim Cost Data Entry View page, the word "UPDATED" displays under the month/year for which data was just entered.
- Continue entering cost data for all applicable months (repeat instruction 6 through instruction 8.) Cost data can be entered and edited on this page as many times as necessary while the cost report is prepared for submission.
- After all cost data is entered, there are two choices:
- Select Return to the Benefit Option List. The cost data entered will be saved, but not submitted to CMS' RDS Center.
The Interim Cost Benefit Options List page displays with the Date of Last Report and Status of Last Report columns updated.
- Submit the reported costs. For information on how to submit the cost report, go to: How do I submit cost reports entered using data entry on the RDS Secure Web Site?
How do I enter gross eligible costs using data entry on the RDS Secure Web Site?
For detailed information on how to prepare cost data using the gross retiree cost method, go to: How to Prepare Cost Data for Submission to the RDS Center, and view Cost Reporting Example Illustrating Gross Retiree Costs.
- Log into the RDS Secure Web Site.
Note: If additional information is needed on field definitions or edits, click on the Help About This Page hyperlink in the Quick Help box on the top right hand corner of the page at any time during this step-by-step process.
- From the Plan Sponsor List With Application Summary page, select the Plan Sponsor ID for which you want to enter costs.
- On the Application List page, find the appropriate Application Number. Select the Interim Costs option in the Actions dropdown list.
Note: The Interim Costs action only displays in the Actions column for Account Managers and Designees assigned the Report Costs privilege during Payment Setup. Designees with the Request Payment privilege do not have access to this page. Payment Requesters for the application only have View Only access to all reported costs from the Payment Request and Audit Trail pages.
Additionally, this action does not display unless the application is approved, Payment Setup is complete, and the application payment frequency is monthly, quarterly, or interim annual.
- Select Go. The Interim Cost Benefit Option List page displays.
This page provides a list of benefit options for which the user has been authorized to enter and/or view interim cost data.
By default, the table is sorted in alphabetical order by Benefit Option Name. To sort the table by a different column, click on the column header link. The column selected sorts in ascending or descending order; an up (ascending) arrow or down (descending) arrow displays at the top of the column. To reverse the order, click the column header link again.
- On the Interim Cost Benefit Option List page, find the appropriate benefit option for which cost data should be entered. From the Actions dropdown list, select the Enter/Update Costs option and select Go.
Note: The Enter/Update Costs option is only available if the Account Manager, Plan Sponsor Designee, or Vendor has been assigned the Report Costs privilege with a "Data Entry" method, the last allowable interim payment request has not been made for the application, and the application has not been reconciled.
The Benefit Option Interim Cost Data Entry View page displays.
This page contains cost figures saved to the RDS Secure Web Site. Data can be added and edited from the page.
- Find the Month/Year for which costs must be entered and select edit. Only one month/year at a time may be edited.
The Benefit Option Interim Cost Data Entry Edit page displays.
This page allows entry of the gross retiree costs, and other cost data, per month.
- For the selected month, provide aggregated retiree data in the following fields: Gross Retiree Costs, Threshold Reduction, and Limit Reduction. Complete the Estimated Cost Adjustment field as applicable. For detailed information on how to determine these amounts, go to: How to Prepare Cost Data.
Note: The threshold reduction is required for at least the first month in the plan year where gross costs were reported. For subsequent months, the threshold reduction is not required; however, it must be entered as applicable.
Cost Threshold - The cost threshold is a federally-defined amount of out-of-pocket expenses paid by, or on behalf of, the beneficiary. The amount up to the cost threshold is not eligible for subsidy. It is adjusted in the same manner as the annual Medicare Part D deductible and the annual Medicare Part D out of pocket threshold and is adjusted annually as defined in 42 CFR §423.104(d)(1)(ii) and (d)(5)(iii)(B), respectively.
Cost Limit - The cost limit is a federally-defined amount of out-of-pocket expenses paid by, or on behalf of, the beneficiary. The amount exceeding the cost limit is not eligible for subsidy. It is adjusted in the same manner as the annual Medicare Part D deductible and the annual Medicare Part D out of pocket limit and is adjusted annually as defined in 42 CFR §423.104(d)(1)(ii) and (d)(5)(iii)(B), respectively.
Gross Retiree Costs - Non-administrative costs incurred under the plan for Medicare Part D drugs (as defined in 42 C.F.R §423.100), whether paid by the plan or retiree or a combination (e.g., co-pay and plan reimbursement). Gross retiree costs may not be reported if estimated premium has been reported for the benefit option.
Threshold Reduction - The amount below the federally defined cost threshold is not eligible for the subsidy. Therefore Plan Sponsors must reduce the amount of gross covered retiree plan-related prescription drug costs. This ineligible subtracted amount is referred to as the threshold reduction.
Limit Reduction - The amount in excess of the federally defined cost limit is not eligible for the subsidy. Therefore Plan Sponsors are not able to claim this excess amount of gross covered retiree plan-related prescription drug costs. This ineligible excess amount is referred to as the limit reduction.
Estimated Cost Adjustment –Estimate of the expected rebates and other price concessions (discounts, chargebacks, etc.) attributable to the gross retiree costs during the year between the cost threshold and the cost limit. This field is not applicable to 2005 plan months.
- After cost data is entered into the appropriate fields, select Save. Select Cancel to return to the Benefit Option Interim Cost Data Entry View page without saving changes.
On the Benefit Option Interim Cost Data Entry View page, the word "UPDATED" displays under the month/year for which data was just entered.
- Continue entering cost data for all applicable months (repeat instruction 6 through instruction 8). Cost data can be entered and edited as many times as necessary from this page during the preparation of cost reports for submission.
- After all cost data is entered, there are two choices:
- Select Return to the Benefit Option List. The cost data will be saved but not submitted to CMS' RDS Center.
The Interim Cost Benefit Options List page displays with the Date of the Last Report and Status of Last Report columns updated.
- Submit the reported costs. For information on how to submit cost reports for inclusion in a payment request, go to: How do I submit cost reports entered using data entry on the RDS Secure Web Site?
How do I submit cost reports entered using data entry on the RDS Secure Web Site?
These steps only apply to data entry cost reports. Cost data may be reported and saved in the RDS Secure Web Site using data entry; however, if the cost data are never submitted, they cannot be included in a payment request.
To submit cost reports to CMS' RDS Center for inclusion in a payment request follow the steps below.
- Log into the RDS Secure Web Site.
Note: If additional information is needed on field definitions or edits, click on the Help About This Page hyperlink in the Quick Help box on the top right hand corner of the page at any time during this step-by-step process.
- From the Plan Sponsor List With Application Summarypage, select the Plan Sponsor ID.
- On the Application List page, find the appropriate Application Number. Select the Interim Costs option in the Actions dropdown list.
- Select Go. The Interim Cost Benefit Options List page displays.
Note: The Interim Costs action will only display in the Actions column for Account Managers and Designees assigned the Report Costs privilege during Payment Setup. Payment Requester Designees will not have access to this page. Payment Requesters for the application will only have View Only access to all reported costs from the Payment Request and Audit Trail pages.
Additionally, this action will not display unless the application is approved, Payment Setup is complete, and the application payment frequency is monthly, quarterly, or interim annual.
- On the Interim Cost Benefit Option List page, find the appropriate benefit option for which cost data should be submitted. From the Actions dropdown list, select the Enter/Update Costs option and select Go.
The Benefit Option Interim Cost Data Entry View page displays. This page displays a list of the most recent interim cost data reported for each month of the plan year.
If new cost data has been entered for a month, the word "UPDATED" displays under the month/year for which data was just entered.
- Select Submit.
The Benefit Option Interim Cost Data Entry Verification page displays.
Note: In some cases the page may display a warning message if information is entered that the system thinks could be an error. Warning messages should be reviewed and ignored if no further action is required.
- Review entries carefully to ensure that the data is correct and ready to be included in the next payment request.
Select Cancel, to return to the Benefit Option Interim Cost Data Entry View page. Cost data will be saved but will NOT be submitted to CMS' RDS Center.
- Select Confirm to submit after carefully reviewing the cost data and to complete the submission process
The Benefit Option Interim Cost Data Entry Confirmation page displays.
The cost report is submitted to CMS' RDS Center for potential inclusion in a payment request.
- Select Continue to return to the Interim Cost Benefit Option List page.
The Interim Cost Benefit Options List page displays with the Date of the Last Report and Status of Last Report columns updated.
How do I report adjusted costs for a month already submitted?
If adjusted or additional claim information is received for the month of May (using May as an example) after May's cost data has been already submitted to CMS' RDS Center, the cost data for May must be re-aggregated, adjusted and resubmitted to CMS' RDS Center. Any other month after May that is affected by the revised retiree cost data must also be adjusted. This can happen, for example, if the change in one month affects the threshold reduction and limit reduction in subsequent months. If there is a change in a month, all cumulative cost data is required to be reported again for that month, not just the adjusted amounts. Interim cost data can be submitted to CMS' RDS Center and revised as often as necessary, whenever necessary, until reconciliation is initiated.
Regardless of whether the cost data being revised has been included in a payment request, the Cost Reporter's actions are the same. Cost Reporters do not need to be concerned about the impact of the revised data to the payment process.
- Log into the RDS Secure Web Site.
Note: If additional information is needed on field definitions or edits, click on the Help About This Page hyperlink in the Quick Help box on the top right hand corner of the page at any time during this step-by-step process.
- From the Plan Sponsor List With Application Summarypage, select the Plan Sponsor ID.
- On the Application List page, find the appropriate Application Number. Select the Interim Costs option in the Actions dropdown list.
Note: The Interim Costs action will only display in the Actions column for Account Managers and Designees assigned the Report Costs privilege during Payment Setup. Designees with the Request Payment privilege will not have access to this page. Designees with the Request Payment privilege for the application will only have View Only access to all reported costs from the Payment Request and Audit Trail pages.
Additionally, this action will not display unless the application is approved, Payment Setup is complete, and the application's payment frequency is monthly, quarterly, or interim annual.
- Select Go. The Interim Cost Benefit Options List page displays.
- On the Interim Cost Benefit Option List page, find the appropriate benefit option for which costs are to be adjusted. From the Actions dropdown list, select the Enter/Update Costs option and select Go. The Benefit Option Interim Cost Data Entry View page displays. This page displays a list of the most recent interim costs reported for each month of the plan year.
- Find the Month/Year for which adjusted costs are to be reported and select edit. Only one month/year may be edited at a time.
The Benefit Option Interim Cost Data Entry Edit page displays.
- To enter adjusted cost data, highlight the dollar amount in each field and replace it with the new cost data. (Zero costs 0.00 are allowed.)
Note: When reporting adjusted cost data, always report the entire months' cost data again, not just the adjusted amount.
- After new cost data has been entered into the appropriate fields, select Save. Select Cancel to return to the Benefit Option Interim Cost Data Entry View page without saving changes.
- Repeat intructions 6 - 8 for each subsequent month that may be affected by the adjusted cost data submitted in the previous month.
For example, assume in the example above the adjustment for February was $75 of gross retiree costs reduced (minus) for retiree Sam Iam. When the $75 cost for Sam Iam was originally reported, $50 of the cost was applied to the threshold reduction for February. Consequently, when February gross costs are reduced, the Threshold Reduction should be reduced by $50. If Sam Iam also had costs submitted for March, the Threshold Reduction would then have to be increased for March by up to that remaining $50.
- On the Benefit Option Interim Cost Data Entry View page, the word "UPDATED" displays for which data was just adjusted.
After all cost reports are entered, there are two choices:
- Select Return to the Benefit Option List. The costs entered will be saved, but not submitted to CMS' RDS Center.
The Interim Cost Benefit Options List page displays with the Date of Last Report and Status of Last Report columns updated. If the revised cost report was not submitted, the status of the last report is no longer "Submitted" and it reverts back to "Saved" until the cost report is resubmitted.
- Submit the reported costs. For information on how to submit cost reports for inclusion in a payment request, go to: How do I submit cost reports entered using data entry on the RDS Secure Web Site?
How do I view reported cost data?
Reported costs may be viewed if at least one cost report is saved using data entry or submitted using the mainframe without errors. The viewable cost reports are the last cost figures accepted for a given month, regardless of whether those cost data are saved, submitted, and/or included in a payment request. For information on how to view all cost reports submitted for a benefit option, go to: How do I view submitted interim cost reports?
With the data entry process, there are two separate steps of saving the entered cost data, and then submitting it; however, cost reports submitted using mainframe are automatically submitted. The steps to view mainframe submitted cost reports and data entry cost reports that are saved or submitted, are the same.
To view cost reports follow the steps below.
- Log into the RDS Secure Web Site.
Note: If additional information is needed on field definitions or edits, click on the Help About This Page hyperlink in the Quick Help box on the top right hand corner of the page at any time during this step-by-step process.
- From the Plan Sponsor List With Application Summarypage, select the Plan Sponsor ID.
- On the Application List page, find the appropriate Application Number. Select the Interim Costs option in the Actions dropdown list.
Note: The Interim Costs action will only display in the Actions column for Account Managers and Designees assigned the Report Costs privilege during Payment Setup. Designees with the Request Payment privilege will not have access to this page. Designees with the Request Payment privilege for the application will only have View Only access to all submitted costs from the Payment Request and Audit Trail pages.
Additionally, this action will not display unless the application is approved, Payment Setup is complete, and the application's payment frequency is monthly, quarterly, or interim annual.
- Select Go. The Interim Cost Benefit Options List page displays.
- Cost Reporter - Displays the Vendor Name and Vendor ID if a Vendor has been assigned the Report Costs privilege for the benefit option. Displays the roles (Account Manager/Designee) assigned to directly report costs for the Plan Sponsor.
- Date of Last Report - Displays the date the Cost Reporter last saved cost figures or last submitted a cost report on the RDS Secure Web Site or the date a mainframe submission containing costs for the benefit option was last processed.
- Status of Last Report - Displays the status of the last cost report.
- Data Entry: Saved - Data Entry status indicating that the last cost report was saved but not submitted.
- Data Entry: Submitted - Data Entry status indicating that the cost report was submitted and is now available for inclusion in a payment request.
- Mainframe: Submitted - Mainframe status indicating that the cost report was submitted and is now available for inclusion in a payment request.
- Mainframe: Errors Detected - Mainframe status indicating that errors were detected in the last report.
- No Reports - No cost reports have been processed (mainframe) or saved/submitted (data entry).
- On the Interim Cost Benefit Option List page, find the appropriate benefit option to view cost data. From the Actions dropdown list, select the View Current Costs option and select Go.
Note: There must be at least one successfully submitted cost report for the Actions dropdown to display.
The Benefit Option Interim Cost Summary page displays. This page displays a list of the most recent interim cost data reported for each month of the plan year.
Note: Edits are not made from this page. This is a View Only page. If the data was supplied using the mainframe, a new file must be submitted to contain the corrected data. For more information when the data was supplied using data entry, go to: What do I need to do to change cost data that was previously submitted?
- When viewing costs is completed, select Continue to return to the Interim Cost Benefit Option List page.
How do I view submitted interim cost reports?
Previously submitted cost reports can be viewed from the Audit Trail of the Benefit Option Interim Cost Reports page. The Audit Trail page displays a list of the benefit option interim cost reports submitted to CMS' RDS Center by the reporting source and a history of the actions taken on these reports. From this page, Designees with the Request Payment privilege, Account Managers, and Cost Reporters assigned to the benefit option may view all activity related to a cost report and the contents of the report.
- Log into the RDS Secure Web Site.
Note: If additional information is needed on field definitions or edits, click on the Help About This Page hyperlink in the Quick Help box on the top right hand corner of the page at any time during this step-by-step process.
- From the Plan Sponsor List With Application Summary page, select the Plan Sponsor ID.
- On the Application List page, find the appropriate Application Number. Select the Interim Costs option in the Actions dropdown list.
- Select Go. The Interim Cost Benefit Options List page displays.
- On the Interim Cost Benefit Option List page, find the appropriate benefit option. Select the View Audit Trail option in the Actions dropdown list.
- Select Go. The Audit Trail of Benefit Option Interim Cost Reports page displays.
Note: Designees with the Request Payment privilege for the application will have View Only access to submitted costs from the Payment Request and Audit Trail pages.
The following information is displayed on the Audit Trail of Benefit Option Interim Cost Reports page for each action taken on a submitted cost report.
- Date/Time Processed – Displays the date and time CMS' RDS Center processed a cost report when an action was taken by a Cost Reporter or Designee with the Request Payment privilege.
- Status – Displays the status of the cost report based on the action that was taken
- Data Entry: Submitted – Data Entry status indicating that the cost report was submitted on the RDS Secure Web Site.
- Mainframe: Submitted – Mainframe status indicating that the cost report was submitted without errors.
- Mainframe: Errors Detected – Mainframe status indicating that the cost report was submitted with errors.
- Included In Payment Request – Indicates that the cost report was included in a payment request.
- Report Reviewed – Indicates that the Payment Requester reviewed the cost report.
- Date/Time File Created (Mainframe Submission Only) – Displays the date and time supplied in the mainframe file submission.
- Cost Reporter / Payment Requester –Displays the name of the Cost Reporter if the status of the cost report indicates a Data Entry action. Displays the name of the Payment Requester if the status indicates that the cost report was "Reviewed" or "Included" in a payment request. If the status indicates a mainframe submission, the text "Mainframe" will be displayed in this column.
- Errors/Warnings Detected – Displays the number of errors and warning detected in the cost report. The number of errors will only appear if the status of the cost report is "Mainframe: Errors Detected". Data Entry submissions with errors are not permitted on the RDS Secure Web Site.
- To view the contents of a cost report in the list, choose the View Cost Report action in the Actions dropdown.
- Select Go. The Benefit Option Interim Cost Report page displays.
- View the information on this page for specific audit trail information regarding the specified cost report.
The example above is a cost report submitted using mainframe with no errors. The Record Errors and Warnings fields indicate "None." If those fields indicated a specific error or warning, select Help About This Page in the Quick Help text box on the top right-hand side of the page to research the error or warning. See below for an example of a mainframe submitted cost report with errors.
For the Benefit Option Non-Union Gold, notice the Status of Last Report column indicates: Plan Sponsor Mainframe to RDS Center Mainframe: Errors Detected.
The Record Errors field indicates estimated premium costs provided for self-funded benefit options. For more information on the errors and warnings presented on this page, select Help About This Page in the Quick Help text box on the top right-hand side of the page.
Since this mainframe report has errors, it cannot be included in a payment request. Any errors can only be corrected by resubmitting the cost report again using mainframe with corrected cost data.
- Select Continue to return to the Audit Trail of Benefit Option Interim Cost Reports page.
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