Covered Retiree List and Interim Cost Reporting

User Roles:

AM

AR

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Program Components:

Retiree Management

Interim Payment

Communicating the Covered Retiree List (CRL) is an essential part of RDS participation.

Plan Sponsors may only submit interim costs for the Qualifying Covered Retirees, Benefit Options, and Subsidy Periods listed in the CRL. Therefore, it is necessary to manage retiree information throughout the lifecycle of an RDS Application. Plan Sponsors should request, download, and review the CRL as part of the interim cost preparation process, comparing internal records against CMS' RDS Center records. It is important that Plan Sponsors communicate any changes to the appropriate parties so that cost preparation does not include drug claims outside of the Subsidy Periods for retirees listed in the CRL.

There are seven actions Plan Sponsors can do when preparing Interim Payment Requests to ensure the CRL is properly communicated and retiree information is managed.

Action 1: Request the CRL

Request the CRL using the RDS Secure Website. The CRL is available when the Application is in an "Approved" status and retirees are approved for subsidy. The CRL may be requested multiple times throughout the plan year. The Authorized Representative, Account Manager, or Designee with View/Send/Receive Retiree Data privilege can request the CRL.

Action 2: Download the CRL

Download the CRL using the RDS Secure Website. The CRL is available within approximately 15 minutes from the time of the request. Save the file in a Comma Separated Value (CSV) format. You may open the file in an Excel spreadsheet, but be sure to import it using the Text Import Wizard. This step avoids truncating any leading zeros found in the file. The Authorized Representative, Account Manager, or Designee with View/Send/Receive Retiree Data privilege can download the CRL.

Action 3: Distribute the CRL

Distribute the CRL to the individuals that scrutinize the list at each Benefit Option level. Include people who manage retiree enrollment, process claims, and report cost data. Each person should receive only the information needed. Since all Benefit Options for an Application are included in the CRL, create separate spreadsheets or documents for distribution to different individuals or teams. Provide the information in a format that is easy to review and provide notes.

Action 4: Scrutinize the CRL

Scrutinize the CRL with the people who manage retiree enrollment, process claims, and report cost data. Many times the enrollment system and the claims processing system are separate. Compare the CRL against both of these systems and internal records. Reconcile any differences to ensure there are no conflicts.

Action 5: Submit Retiree Changes to CMS' RDS Center

Submit retiree changes to CMS' RDS Center in the form of a Retiree File. The file may be uploaded to CMS' RDS Center using the Upload Retiree File page on the RDS Secure Website. It may also be submitted using a Vendor Connect:Direct connection to CMS' RDS Center, or a Coordination of Benefits (COB): Voluntary Data Sharing Agreement (VDSA) or Mandatory Insurer Reporting (MIR), or using a Plan Sponsor Connect:Direct connection to CMS' RDS Center Mainframe. How the Retiree File is submitted depends on a Plan Sponsor's Electronic Data Interchange (EDI) Methods and Sources.

Action 6: Process Retiree Response Files and Retiree Notification Files

Process Retiree Response Files and Retiree Notification Files received from CMS' RDS Center. Retiree Response Files are created whenever CMS' RDS Center receives a Retiree File on behalf of the Plan Sponsor and Weekly Notification Files are created when beneficiaries approved for subsidy under the Application have a notification event (for example: a change in Medicare entitlement). The processing of these files may include settling discrepancies with those who manage retiree enrollment, process claims, or report cost data. Changes are submitted to CMS' RDS Center in the form of a Retiree File.

Action 7: Communicate the Updated CRL to Cost Reporters

Once discrepancies are settled, communicate the updated CRL to Cost Reporters. This requires the Plan Sponsor to repeat Action 1: Request the CRL and Action 2: Download the CRL. Since the CRL includes the Plan Sponsor’s full array of Benefit Options, it may need to be divided and communicated separately to multiple Cost Reporters. The cost data prepared and submitted by a Plan Sponsor’s Cost Reporters should not include data for anything outside the Qualifying Covered Retirees, Benefit Options, and Subsidy Periods listed in the CRL.

Plan Sponsors who follow these seven actions provide better communication of the CRL during interim cost reporting.

If you have questions or need additional information, contact CMS' RDS Center.