Retiree Management

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Retiree Management

This page contains answers to Common Questions about retiree management. Review this page to learn about how to process retiree files, how to troubleshoot retiree processing issues, and more. For additional information refer to the Retiree Management section of the RDS User Guide.

What is a Qualifying Covered Retiree (QCR)?

ANSWER: A Qualifying Covered Retiree (QCR) is an RDS eligible retiree or beneficiary. A QCR must be a retiree, spouse, or dependent; must be covered under the Plan Sponsor's Prescription Drug Plan; and eligible for but not enrolled in a Medicare Part D plan.

Answer ID: 700-1
Date Posted: 10/17/2014

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How do I exchange retiree information with CMS' RDS Center?

ANSWER: Electronic Data Interchange (EDI) is the electronic transmission of data between computer systems.

All participants in the RDS Program must use EDI to exchange retiree files with CMS' RDS Center throughout the Application Lifecycle.

Information is exchanged using a Comma Separated Value (CSV) file or Mainframe file where each line represents one beneficiary, Benefit Option, and Subsidy Period.

Answer ID: 700-2
Date Posted: 10/17/2014

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What are the Retiree List Submission Methods and Retiree List Response Methods?

ANSWER: The Retiree Electronic Data Interchange (EDI) Methods and Sources are selected in Step 7 of the Application Submission Process.

Note: After an application is in "Submitted" status, the Plan Sponsor can return to Step 7: Retiree Electronic Data Interchange (EDI) Methods and Sources and update or change the EDI information.

Retiree List Submission Methods and Retiree List Response Methods are:

  • RDS Secure Website to RDS Center
  • Vendor Mainframe to RDS Center Mainframe
  • Vendor Mainframe to RDS Center Mainframe with a copy of the response file sent to the RDS Secure Website
  • Coordination of Benefits (COB): Voluntary Data Sharing Agreement (VDSA) or Mandatory Insurer Reporting (MIR)
  • Coordination of Benefits (COB): Voluntary Data Sharing Agreement (VDSA) or Mandatory Insurer Reporting (MIR) with a copy of the response file sent to the RDS Secure Website
  • Plan Sponsor Mainframe to RDS Center Mainframe
  • Plan Sponsor Mainframe to RDS Center Mainframe with a copy of the response file sent to the RDS Secure Website

Answer ID: 700-3
Date Posted: 10/17/2014

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What is retiree processing?

ANSWER: During retiree processing, the Plan Sponsor provides demographic and benefit enrollment information about the beneficiaries for whom it is seeking subsidy. CMS' RDS Center evaluates program eligibility and provides the Plan Sponsor with approved Subsidy Periods for each Qualifying Covered Retiree (QCR).

The main components of retiree processing include:

  • Selecting the Retiree Electronic Data Interchange (EDI) Methods and Sources on the RDS Secure Website during the Application Submission Process
  • Sending a Valid Initial Retiree List to CMS' RDS Center as part of a timely and complete RDS application prior to the expiration of the Application Deadline
  • Sending Monthly Retiree Lists that only include detail records of individuals for whom there is a change of information from the Valid Initial Retiree List
  • Processing Retiree Response Files so internal records reflect the correct QCR information and associated Subsidy Periods
  • Processing Weekly Notification Files so internal records reflect the correct QCR information and associated Subsidy Periods
  • Requesting, downloading, and reviewing Covered Retiree Lists (CRL) for comparison against the Plan Sponsor's internal records with those of CMS' RDS Center
  • Reviewing Qualified Covered Retiree Counts for the most recent retiree data derived from the Retiree Response File and Weekly Notification Files

Answer ID: 700-4
Date Posted: 10/17/2014

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What is a Valid Initial Retiree List?

ANSWER: For more information about Valid Initial Retiree Lists, refer to Common Question 600-6.

Answer ID: 700-5
Date Posted: 10/17/2014

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What is a Monthly Retiree List?

ANSWER: Changes to retiree information throughout the plan year for a given application should be included in Monthly Retiree Lists. The Monthly Retiree List is submitted by a Plan Sponsor or Vendor for a given application to maintain accurate beneficiary data.

The first Monthly Retiree List should be sent to CMS' RDS Center approximately 30 days from the date the initial Retiree Response File was received and processed by the Plan Sponsor or Vendor. This list must be in the same format as the Valid Initial Retiree List, with only detail records of beneficiaries having a change of information.

A Monthly Retiree List is not required if no information has changed for a given month.

A Retiree Response File is sent for each Monthly Retiree List received by CMS' RDS Center.

Answer ID: 700-6
Date Posted: 10/17/2014

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What is the difference between response files and notification files?

ANSWER: Response Files: When a Plan Sponsor submits a Valid Initial Retiree List or Monthly Retiree List for an RDS application, CMS' RDS Center verifies the Medicare entitlement for each beneficiary by checking the Medicare Beneficiary Database (MBD) system of record for this information. CMS' RDS Center sends a Retiree Response File that includes a record for each Qualifying Covered Retiree (QCR) sent in the retiree list indicating the period of time during the plan year that the Plan Sponsor may claim subsidy.

The Retiree Response File records contain all the original fields sent by the Plan Sponsor, plus the Determination Indicator, Subsidy Dates, and Reason Codes. The Retiree Response File may contain multiple responses (records) for a single beneficiary in the event that there is a gap in subsidy based on Medicare entitlement. Retiree response records should be reviewed and processed as soon as possible to assure accurate cost reporting. Response records containing Reason Codes may require research. Reason Codes are identification numbers that correspond to a specific message about a record in a response file. For a list of Reason Codes, refer to RDS Reason Codes.

Notification Files: When there is an event that may impact a Plan Sponsor's ability to receive subsidy for a beneficiary, CMS' RDS Center is notified by Medicare. When CMS' RDS Center receives notifications from Medicare, the system re-evaluates the beneficiary's eligibility for subsidy. 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 a beneficiary, disenrollment, enrollment, or attempted enrollment into a Medicare Part D plan.

CMS' RDS Center conveys notifications and any resulting changes in approved subsidy periods to Plan Sponsors using Weekly Notification Files that are sent once a week when beneficiaries covered under the application have a notification event. The Weekly Notification Files contain all the original data elements that the Plan Sponsor sent in the most recent Monthly Retiree List, plus the Determination Indicator, Reason Codes, Subsidy Period Effective Date, and the Subsidy Period Termination Date. The transaction type data element will be left blank. CMS' RDS Center only sends a notification for retirees who have ever qualified for an RDS Subsidy Period. A notification record is not generated if the retiree never qualified for the RDS subsidy (regardless of the reason).

 

Answer ID: 700-7
Date Posted: 10/17/2014

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What is a Covered Retiree List and why is it important to communicate this list when participating in the Retiree Drug Subsidy (RDS) Program?

ANSWER: The Covered Retiree List (CRL) is a vital piece of a Plan Sponsor's Application Submission Process within the RDS Program. Communicating and managing the CRL throughout the Application Lifecycle ensures that the enrollment system and claims processing system are in sync especially when reporting costs for Interim Payments. Maintaining the accuracy of this list is also a crucial step during the Reconciliation process.

For more information on the importance of the CRL, refer to the Snippet training entitled "Communicating the Covered Retiree List" located in the Snippets section of the RDS Program Website Resource Library.

Answer ID: 700-8
Date Posted: 10/17/2014

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What is a Medicare Part D Enrollment Rejection Notification File?

ANSWER: A Medicare Part D Enrollment Rejection Notification File is information provided by CMS' RDS Center advising the Plan Sponsor that a beneficiary, for whom they are requesting subsidy, has attempted to enroll in Medicare Part D. For more information, refer to Medicare Part D Enrollment Rejection Notifications.

Answer ID: 700-9
Date Posted: 10/17/2014

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What are Current Covered Retiree Counts?

ANSWER: Qualifying Covered Retiree (QCR) counts are available on the RDS Secure Website after the RDS application is approved by CMS' RDS Center. The retiree counts are calculated from the approved retiree Subsidy Periods. The retiree counts are refreshed on a daily basis and reflect the most recent retiree data derived from the Retiree Response File and Weekly Notification Files. When Reconciliation Step 4: Finalize Covered Retirees is marked "Complete," the retiree counts are frozen and are no longer recalculated. For more information, refer to Current Covered Retiree Counts.

Answer ID: 700-10
Date Posted: 10/17/2014

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Who can access and complete retiree processing tasks?

ANSWER: Account Managers, Authorized Representatives, Designees assigned the View/Send/Receive Retiree Data privilege, and/or Designees with the Choose Retiree Electronic Data Interchange (EDI) Methods and Sources privilege may access and complete retiree processing tasks. For more information, refer to User Roles in Retiree Processing.

Answer ID: 700-11
Date Posted: 10/17/2014

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How do I submit a Valid Initial Retiree List and Monthly Retiree List using the RDS Secure Website?

ANSWER: For information about Valid Initial Retiree List and Monthly Retiree List processing, as well as step-by-step instructions to upload a retiree file on the RDS Secure Website, refer to Submit a Valid Initial Retiree List and Monthly Retiree List.

Answer ID: 700-12
Date Posted: 10/17/2014

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Who can submit a Valid Initial Retiree List and Monthly Retiree List?

ANSWER: The Authorized Representative, Account Manager, and Designee with View/Send/Receive Retiree Data privilege can submit the Valid Initial Retiree List and Monthly Retiree Lists using the RDS Secure Website.

Vendors and Plan Sponsors with pre-existing Mainframe connections can submit the Valid Initial Retiree List and Monthly Retiree Lists to CMS' RDS Center.

VDSA partners submitting non-Medicare Secondary Payer (MSP) records and Mandatory Insurer Reporting (MIR) participants using the expanded implementation model can submit the Valid Initial Retiree List and Monthly Retiree Lists to CMS' RDS Center.

Answer ID: 700-13
Date Posted: 10/17/2014

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Who can download Retiree Response Files?

ANSWER: The Account Manager and Designee with View/Send/Receive Retiree Data privilege may download Retiree Response Files on the RDS Secure Website.

Answer ID: 700-14
Date Posted: 10/17/2014

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How do I process Retiree Response Files?

ANSWER: For information about Retiree Response File processing, as well as step-by-step instructions to download a Retiree Response File, refer to Process Retiree Response Files.

Answer ID: 700-15
Date Posted: 10/17/2014

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How do I process Weekly Notification Files?

ANSWER: For information about Weekly Notification File processing, as well as step-by-step instructions to download Weekly Notification Files, refer to Process Weekly Notification Files.

Answer ID: 700-16
Date Posted: 10/17/2014

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Who can download Weekly Notification Files?

ANSWER: The Authorized Representative, Account Manager, and Designee with View/Send/Receive Retiree Data privilege may download Weekly Notification Files.

Answer ID: 700-17
Date Posted: 10/17/2014

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How do I request a Covered Retiree List?

ANSWER: For information about Covered Retiree Lists, including step-by-step instructions to request and download a Covered Retiree List, refer to Request a Covered Retiree List.

Answer ID: 700-18
Date Posted: 10/17/2014

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Who can request a Covered Retiree List?

ANSWER: The Authorized Representative, Account Manager, and Designee with View/Send/Receive Retiree Data privilege may request a CRL.

The Authorized Representative and the Account Manager may download the CRL. A Designee with View/Send/Receive Retiree Data privilege may access the Download Covered Retiree List page using the Manage Retirees page.

For more information about who can request a CRL during Reconciliation, refer to Finalizing Retirees for Reconciliation.

Answer ID: 700-19
Date Posted: 10/17/2014

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How do I view Medicare Part D Enrollment Rejection Notifications?

ANSWER: For information about Medicare Part D Enrollment Rejection Notifications, including step-by-step instructions to view them, refer to View Medicare Part D Enrollment Rejection Notifications.

Answer ID: 700-20
Date Posted: 10/17/2014

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Who can access Medicare Part D Enrollment Rejection Notifications?

ANSWER: The Authorized Representative, Account Manager, and Designee with View/Send/Receive Retiree Data privilege may access Medicare Part D Enrollment Rejection Notifications.

Answer ID: 700-21
Date Posted: 10/17/2014

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What are reason codes?

ANSWER: Reason codes are identification numbers that correspond to a specific message about a record in a response file or a notification file. Refer to RDS Reason Codes for more information.

Answer ID: 700-22
Date Posted: 10/17/2014

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What data is included in a retiree file?

ANSWER: A retiree file includes a number of data elements, including Application ID, beneficiary information, and transaction type. For a listing of the data elements, as well as a description of each, refer to Retiree File Layouts.

Answer ID: 700-23
Date Posted: 10/17/2014

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What are the transaction types in a retiree file?

ANSWER: There are 3 transactions types in a retiree file. They include:

  • Value 'ADD' = The beneficiary has either never been submitted for the corresponding RDS Application ID, or was submitted but never accepted for a Subsidy Period.
  • Value 'UPD' = The beneficiary and the corresponding UBOI have been previously accepted for a Subsidy Period for the corresponding RDS application and updated information is being sent.
  • Value 'DEL' = The beneficiary has been previously approved for subsidy for the corresponding RDS application and Benefit Option. All coverage under this Benefit Option for this Qualifying Covered Retiree (QCR) should be removed.

Answer ID: 700-24
Date Posted: 10/17/2014

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What is a Comma Separated Value (CSV) file?

ANSWER: This 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.

Answer ID: 700-25
Date Posted: 10/17/2014

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What does MBD stand for?

ANSWER: MBD stands for Medicare Beneficiary Database. It is the system of record for all Medicare Beneficiary data. CMS' RDS Center verifies the Medicare entitlement for each retiree using this database.

Answer ID: 700-26
Date Posted: 10/17/2014

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I’m experiencing issues with retiree processing tasks. Are there any tips available to help troubleshoot common issues?

ANSWER: Yes. For tips and tricks to assist in solving some of the most commonly encountered retiree problems, refer to Troubleshooting Exchanging Retiree Information With CMS' RDS Center.

Answer ID: 700-27
Date Posted: 10/17/2014

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Are there any resources available for reference to assist with processing retiree information?

ANSWER: Yes. The following retiree processing resources are available for reference:

  • Retiree File Layouts: This page contains the Retiree File RDS Secure Website CSV File Layout, Retiree File Mainframe Record Layout, and Retiree File Submissions Record Layout.
  • Weekly Notification File Layouts: This page contains the Weekly Notification Files RDS Secure Website CSV File Layout, Weekly Notification File Mainframe Record Layout, and Weekly Notification Record Layout.
  • Covered Retiree List Layout and Format: This page contains information about the Covered Retiree List File Layout, as well as the Covered Retiree List File Format.
  • Retiree File Upload Errors: This page lists the errors that might be encountered when uploading a retiree file on the RDS Secure Website.
  • Mainframe Retiree List Copybook: This page contains the Mainframe Retiree List Copybook.
  • Retiree Response File Layouts: This page contains the CSV File Layout of Retiree Response Files on the RDS Secure Website, Retiree Response Files Record Layout, Retiree Response Files Mainframe Record Layout, and Mainframe Retiree Response File Copybook.
  • RDS Reason Codes: This page contains the reason codes that correspond to a specific message about a record in a response file or a notification file.

Answer ID: 700-28
Date Posted: 10/17/2014

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