|
Field # |
Field |
Sample Data |
Description |
Derived |
|
1 |
Recipient |
ABC Healthcare |
Name of report recipient |
No |
|
2 |
Recipient Role |
Account Manager |
Role of person as assigned by the RDS Secure Website |
No |
|
3 |
Recipient Vendor |
John Fakename |
Name of individual associated with Vendor |
No |
|
4 |
Cost Reporting Alert |
101 |
Numeric value of Alert |
No |
|
5 |
Cost Reporting Alert Description |
No Reports: Interim Cost Reporting Open |
Text description of Alert |
No |
|
6 |
Plan Sponsor ID |
999999 |
A unique number assigned to a Plan Sponsor for the duration of their participation in the RDS Program |
No |
|
7 |
Organization Name |
Fake Technology Company |
The legal entity name of the Plan Sponsor |
No |
|
8 |
Account Manager Name |
Louis Fakename |
Name of Account Manager associated with the Plan Sponsor |
No |
|
9 |
Authorized Representative Name |
Joseph Fakename |
Name of Authorized Representative associated with the Plan Sponsor |
No |
|
10 |
Authorized Representative Verification Status |
Approved |
Indicates whether the Plan Sponsor has approved the Authorized Representative to act on the Plan Sponsor's behalf |
No |
|
11 |
Application ID |
84361 |
A unique number assigned to an Application that does not change |
No |
|
12 |
Plan Name |
Fake Rx Plan |
Name associated with the Application |
No |
|
13 |
Plan Year Start Date |
2008-01-01 |
The beginning date defining the Plan Year |
No |
|
14 |
Plan Year End Date |
2008-12-31 |
The ending date defining the Plan Year |
No |
|
15 |
Application Status |
Reconciliation Cost Reporting Opened |
Current Status of the Application |
No |
|
16 |
Application Status Date |
2009-09-18 |
The date associated with the latest Application Status |
No |
|
17 |
Interim Payment Frequency |
Monthly |
Indicates how frequently the Plan Sponsor can request payment on the Application |
No |
|
18 |
Total Paid To Date |
52132.82 |
Total amount that has been paid to date for the Application |
No |
|
19 |
Retiree Submissions Ready |
Closed |
Open/Closed indicator of whether or not retiree files were accepted by CMS' RDS Center |
Yes |
|
20 |
Retiree List Submission Method |
RDS Secure Website to RDS Center |
Retiree data submission method to CMS' RDS Center; defined during the Application Process |
No |
|
21 |
Submitter ID |
999999 |
Submitter ID associated to the Vendor, Plan Sponsor, VDSA, or MIR submitting retiree files |
No |
|
22 |
Submitter Name |
Gregory Fakename |
Submitter name associated to the Vendor, Plan Sponsor, VDSA, or MIR submitting retiree files |
No |
|
23 |
Retiree List Response Method |
RDS Secure Website to RDS Center |
The method by which retiree data is communicated to the Submitter or Plan Sponsor. |
No |
|
24 |
Weekly Notification File Delivery Method |
RDS Secure Website only |
Delivery method for notifications from CMS' RDS Center concerning Qualifying Covered Retirees |
No |
|
25 |
Last Covered Retiree List Created Date |
2009-06-04 |
The last date that a Covered Retiree List was generated for the Application |
No |
|
26 |
Payment Setup Complete |
Yes |
A Yes/No indicator that all steps of Payment Setup are complete |
Yes |
|
27 |
Cost Report Ready |
Final Open |
Indicates whether Cost Reports are ready to be accepted by CMS' RDS Center |
Yes |
|
28 |
Reconciliation Deadline Date |
2010-03-31 |
Date Reconciliation must be completed by to avoid an overpayment |
No |
|
29 |
Last Completed Recon Step |
5 |
The Reconciliation step last completed by the Plan Sponsor |
No |
|
30 |
Recon Step Date/Time |
2010-09-18 13:42:05 |
Date and time the Plan Sponsor completed the Reconciliation step |
No |
|
31 |
Benefit Option Name |
UboiA |
Name of a particular benefit design, category of benefits, or cost-sharing arrangement offered within a group health plan |
No |
|
32 |
Unique Benefit Option Identifier |
00ASO2002 |
A unique identifier for each Benefit Option on the Application |
No |
|
33 |
UBOI Eligible Retiree Count |
14 |
Unique number of eligible retirees associated with the Benefit Option |
No |
|
34 |
Multiple Cost Reporters Assigned |
No |
A Yes/No indicator that multiple sources have been assigned to report costs for the Benefit Option |
Yes |
|
35 |
Costs Accepted From Another Reporting Source |
Yes: Interim Costs Greater Than Zero |
Indicates if a Benefit Option has costs greater than zero from more than one source |
No |
|
36 |
Cost Reporter Type |
A01 |
Vendor Identifier or the text "Plan Sponsor" |
No |
|
37 |
Last Cost Report Accepted File Receipt Date/Time |
2008-08-02 14:18:07 |
The file receipt date/time associated with the last Cost Report for the Benefit Option accepted by CMS' RDS Center |
No |
|
38 |
Last Cost Report Accepted Processed Date |
2008-08-03 |
The date a Cost Report submitted by the Cost Reporter was last accepted by CMS' RDS Center for the given Benefit Option |
No |
|
39 |
Last Cost Report Accepted Status |
Included in Payment Request |
This is the most current status associated with the last Cost Report accepted by CMS' RDS Center |
No |
|
40 |
Last Cost Report Accepted Status Date |
2008-10-21 |
The date associated with the Last Cost Report Accepted Status |
No |
|
41 |
Last Cost Report Accepted Type |
Interim |
The timing of the most recently accepted Cost Report (Interim or Final) |
No |
|
42 |
Last Cost Report Accepted Allowable Retiree Cost |
45452.98 |
The total Allowable Retiree Costs for the Benefit Option included in the last Cost Report accepted by CMS' RDS Center |
No |
|
43 |
Last Cost Report Rejected File Receipt Date/Time |
2008-09-18 12:12:07 |
File receipt date and time associated with the last Cost Report for the Benefit Option rejected by CMS' RDS Center |
No |
|
44 |
Last Cost Report Rejected File Processed Date |
2008-09-20 |
The date a Connect:Direct Cost Report submitted by the Cost Reporter was last rejected by CMS' RDS Center for the Benefit Option |
No |
|
45 |
Last Cost Report Rejected Status |
Connect:Direct Errors Detected |
Indicates that errors were detected in the Connect:Direct Cost Report |
No |
|
46 |
Last Cost Report Rejected Type |
Final |
The timing of the most recently rejected Cost Report (Interim or Final) |
No |
|
47 |
Last Cost Report Rejected Allowable Retiree Cost |
82321.56 |
The total Allowable Retiree Costs for the Benefit Option included in the last Cost Report rejected by CMS' RDS Center |
No |
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