File Format for QAR Cost Reporting Exception Detail Report

User Roles:

AM

AR

D

V

Field # Field Sample Data Description
1 Recipient ABC Healthcare Name of Vendor or Plan Sponsor recipient
2 Recipient Role Account Manager Role of person as assigned by the RDS Secure Website
3 Recipient Vendor John Jacobson Name of individual associated with Vendor
4 Plan Sponsor ID 6843 A unique number assigned to a Plan Sponsor for the
duration of their participation in the RDS Program
5 Organization Name Ironclad Technologies The legal entity name of the Plan Sponsor
6 Application ID 84361 A unique number assigned to an Application that does not change
7 Unique Benefit Option Identifier 00ASO2002 A unique identifier for each Benefit Option on the Application
8 UBOI Eligible Retiree Count 14 Unique number of eligible retirees associated with the Benefit Option
9 UBOI Monthly Eligible Retiree Count 10 Unique number of eligible retirees for the reported month
10 Cost Reporter Type A01 Vendor Identifier or the text "Plan Sponsor"
11 File Receipt Date/Time 2010-02-04 12:12:07 Date and time that the file was received by CMS' RDS Center
12 File Processed Date 2010-02-05 Date the file was processed by CMS' RDS Center
13 Plan Month 201002 Reported month and year with error in the Cost Report
14 Exception Type Warning Indicates "Error" or "Warning"
15 Exception Code 110 Numeric value of Exception Code
16 Exception Mainframe edits, Payment setup is
not complete for the Application
Text description of Exception Code in the Cost Report