Weekly Notification File Layouts

^Application ID

10

The RDS Application ID related to the notifications in this file. Includes leading zeroes as needed to completely fill field.

^SSN

09

Social Security Number (SSN) that was last submitted for this beneficiary. This field may be blank if a Medicare beneficiary identifier was provided.

^Medicare beneficiary identifier

12

Medicare beneficiary identifier that was last submitted for this beneficiary.

This field may be blank if an SSN was provided.

May contain:

• Medicare Beneficiary Identifier (MBI) that was submitted for this beneficiary.
• Medicare Health Insurance Claim Number (HICN) that was submitted for this beneficiary.
• Railroad Retirement Board (RRB) number that was submitted for this beneficiary.

^First Name

30

First Name that was last submitted for this beneficiary.

Middle Initial

01

Optional field. Middle Initial that was last submitted for this beneficiary.

^Last Name

40

Last Name that was last submitted for this beneficiary.

^Date of Birth

08

Date of Birth that was last submitted for this beneficiary. Format: CCYYMMDD

^Gender

01

Gender that was last submitted for this beneficiary.
Value '0' = Gender Unknown
Value '1' = Male
Value '2' = Female

^Coverage Effective Date

08

The date that was last submitted for this beneficiary's (retiree, spouse, or dependent) coverage to begin under the Plan Sponsor's prescription drug Benefit Option. Format: CCYYMMDD

^Coverage Termination Date

08

The date the beneficiary's (retiree, spouse, or dependent) coverage under the Plan Sponsor's Prescription Drug Benefit Option ends. Format: CCYYMMDD

This field accepts 99999999 or may be left blank if the date is unknown.

^Unique Benefit Option Identifier

20

Unique Benefit Option Identifier (UBOI) (for example, Rx group number under which this beneficiary was submitted for subsidy.)

^Relationship to Retiree

02

Relationship to retiree that was last submitted for this beneficiary.
Value '01' = Self
Value '02' = Spouse
Value '03' = Other

^Transaction Type

03

Blank = No transaction types are listed in Weekly Notification Files.

Determination Indicator

01

Value 'Y' = Yes, the retiree qualifies for all or some portion of RDS subsidy previously approved.
Value 'N' = No, the retiree does not qualify for RDS subsidy.
Blank = The subsidy Determination Indicator is unchanged since the last Retiree Response File.

Reason Code

02

For more information, refer to RDS Reason Codes.

Subsidy Period Effective Date

08

The effective date of the Subsidy Period for which this Qualifying Covered Retiree (QCR) is approved.
For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes.
Format: CCYYMMDD

Subsidy Period Termination Date

08

The termination date of the Subsidy Period for which this Qualifying Covered Retiree (QCR) is approved.
For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes.
Format: CCYYMMDD

Record Type

PIC X(01)

Value 'H' = Header Record

Application ID

PIC X(10)

The number assigned to the application by CMS' RDS Center. Includes leading zeroes as needed to completely fill field.

Creation Date

PIC X(08)

Date the file was created. Format: CCYYMMDD

Creation Time

PIC X(06)

Time the file was created. Format: HHMMSS

Filler

PIC X(175)

Spaces

Record type

PIC X(01)

Value 'D' = Detail Record

^SSN

PIC X(09)

Social Security Number (SSN) that was last submitted for this beneficiary. This field may contain spaces if a Medicare beneficiary identifier was provided.

^Medicare beneficiary identifier

PIC X(12)

Medicare beneficiary identifier that was last submitted for this beneficiary.

This field may contain spaces if an SSN was provided.

May contain:

• Medicare Beneficiary Identifier (MBI) that was submitted for this beneficiary.
• Medicare Health Insurance Claim Number (HICN) that was submitted for this beneficiary.
• Railroad Retirement Board (RRB) number that was submitted for this beneficiary.

^First Name

PIC X(30)

First Name that was last submitted for this beneficiary.

Middle Initial

PIC X(01)

Optional field. Middle Initial that was last submitted for this beneficiary.

^Last Name

PIC X(40)

Last Name that was last submitted for this beneficiary.

^Date of Birth

PIC X(08)

Date of Birth that was last submitted for this beneficiary. Format: CCYYMMDD

^Gender

PIC X(01)

Gender that was last submitted for this beneficiary.
Value '0' = Gender Unknown
Value '1' = Male
Value '2' = Female

^Coverage Effective Date

PIC X(08)

The date that was last submitted for this beneficiary's (retiree, spouse, or dependent) coverage to begin under the Plan Sponsor's Prescription Drug Benefit Option. Format: CCYYMMDD

^Coverage Termination Date

PIC X(08)

The date the beneficiary's (retiree, spouse, or dependent) coverage under the Plan Sponsor's Prescription Drug Benefit Option ends. Format: CCYYMMDD

This field accepts 99999999 if the date is unknown.

^Unique Benefit Option Identifier (UBOI)

PIC X(20)

Unique Benefit Option Identifier (UBOI) (for example, Rx group number under which this beneficiary was submitted for subsidy.)

^Relationship to Retiree

PIC X(02)

Relationship to retiree that was last submitted for this beneficiary.
Value '01' = Self
Value '02' = Spouse
Value '03' = Other

Transaction Type

PIC X(03)

Blank: No transaction types are listed in Weekly Notification Files.

Determination Indicator

PIC X(01)

Value 'Y' = Yes, the retiree qualifies for all or some portion of RDS subsidy.
Value 'N '= No, the retiree does not qualify for all or some portion of RDS subsidy.
Blank = The subsidy Determination Indicator is unchanged since the last Retiree Response File.

Reason Code

PIC X(02)

For more information, refer to RDS Reason Codes.

Subsidy Period Effective Date

PIC X(08)

The effective date of the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved.
For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes.
Format: CCYYMMDD

Subsidy Period Termination Date

PIC X(08)

The termination date of the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved.
For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes.
Format: CCYYMMDD

Record Type

PIC X(01)

Value 'T' = Trailer Record

Application ID

PIC X(10)

The Application ID pertaining to the notifications in this file. Includes leading zeroes as needed to completely fill field.

Creation Date

PIC X(08)

Date the file was created. Format: CCYYMMDD

Creation Time

PIC X(06)

Time the file was created. Format: HHMMSS

Number of Detail Records

PIC X(07)

Right justified and zero filled. Includes leading zeroes as needed to completely fill field.

Filler

PIC X(168)

Spaces