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RDS Program Components

Additional Program Tasks

Quick Access Reports (QAR)

Supplemental Information

Process Retiree Response Files

User Roles:

AM

AR

D

Program Components:

Retiree Management

Overview

This section provides an overview of the following topics related to processing Retiree Response Files:

Important Information About Processing Retiree Response Files

RDS users can download Retiree Response Files from the RDS Secure Website if they have selected the RDS Secure Website Response Method for one or more Benefit Options on the application and have submitted Qualifying Covered Retirees (QCRs) through this method. Additionally, RDS users that have selected Mainframe with a copy of all response files sent to the RDS Secure Website Response Method or Voluntary Data Sharing Agreement (VDSA) or Mandatory Insurer Reporting (MIR) through CMS' Coordination of Benefits (COB) Contractor with a copy of all response files sent to the RDS Secure Website Response Method may download Retiree Response Files from the RDS Secure Website.

When you receive a Retiree Response File, consider the following:

  • CMS' RDS Center requests that you review and process the information in the Retiree Response Files as soon as possible.
  • Plan Sponsors must process Retiree Response Files and post Subsidy Periods in their internal systems so that the appropriate cost calculations may be performed. Federal law requires that the Plan Sponsor submit cost data only for the Qualifying Covered Retirees (QCR), corresponding Subsidy Periods, and the Benefit Option in which the QCR is enrolled.
  • If you receive a Retiree Response File and a retiree record has a Reason Code, it is an indicator that the beneficiary was not approved for the entire Subsidy Period you requested. Check the Determination Indicator and the Subsidy Period Begin and End Dates in addition to the Reason Code.
  • Use all the information available to you on the RDS Program Website and in the RDS User Guide about the Reason Codes and their specific interpretations when applying the response data to your internal databases.
  • If subsidy is being requested for the spouse or dependant of a Qualifying Covered Retiree (QCR) make sure the information provided in this record is the spouses or dependants, and not that of the retiree.
  • When Reconciliation Step 4: Finalize Covered Retirees is marked "Complete" or the Reconciliation Deadline has passed for that application, CMS' RDS Center no longer processes any retiree list submitted through the Mainframe, VDSA, MIR, or the RDS Secure Website. A Retiree Response File is sent with Reason Code 28: File Rejected - Closed application is sent in the Retiree Response File indicating that the file was not processed by CMS' RDS Center.

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Timing: Processing Retiree Response Files

It takes CMS' RDS Center approximately five to seven days to process the Valid Initial Retiree List and approximately three to five days to process a Monthly Retiree List. If more than seven days pass without receiving the Retiree Response File, contact CMS' RDS Center.

Note: CMS' RDS Center does not process a retiree file and sends a response file with the appropriate reason for rejection if the Application Status is marked “Denied,” “Deleted,” “Withdrawn,” “Reconsideration Requested,” “Reopening Requested,” “Appeal Under Review,” if Reconciliation Step 4: Finalized Covered Retirees is marked "Complete," the Reconciliation Deadline has passed for the application or the file is submitted using the wrong source or method.

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Emails About Retiree Response Files

The Account Manager and Designee with View/Send/Receive Retiree Data privilege receives an email indicating that the monthly Retiree Response Files are available for download on the RDS Secure Website if this is the selected Retiree Electronic Data Interchange (EDI) Method.

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User Roles to Download Retiree Response Files

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

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Response File Layouts and Copybook

The following Response File layouts and copybook are available for reference:

Evaluating Retiree Response Files

The retiree response records contain all original fields (marked with a caret (^)) sent by the Plan Sponsor in the Retiree File, plus the Determination Indicator, Subsidy Period Effective Date and Subsidy Period Termination Date, and Reason Code. The Plan Sponsor may receive multiple responses (records) for a single beneficiary if there is a gap in the beneficiary's coverage or if the beneficiary is enrolled in multiple Benefit Options.

While evaluating Retiree Response Files, consider the following requirements:

  • If Subsidy is being requested for the spouse or dependant of a Qualifying Covered Retiree make sure the information provided in this record is the spouses or dependants and not that of the retiree.
  • The Retiree Response File has the same name as the retiree file to which it corresponds with the prefix of "Resp_". For example, if the file you uploaded was named 2010RetireeList.csv, the Retiree Response File will be named Resp_2010RetireeList.csv.

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Response File Reason Codes

To review the possible reason codes for Retiree Response Files, refer to RDS Reason Codes.

Disclaimer: Due to the sensitive nature of this information, CMS' RDS Center is not at liberty to discuss specific entitlements with Plan Sponsors.

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Step-by-Step Instructions

This section provides step-by-step instructions to download Retiree Response Files from the RDS Secure Website.

To access the RDS Secure Website, and navigate to the Application List page, review instructions to access the RDS Secure Website.

You may choose one of the following methods for accessing the Manage Retirees page:

From the Application List page:

  1. Find the appropriate Application ID.
  2. Select Manage Retirees from the Actions dropdown menu then select Go.

     Select [Manage Retirees]

Or

From the Application Status page:

  1. Go to the Application Maintenance Options section at the bottom of the Application Status page.
  2. Select the Manage Retirees link.

     Select [Manage Retirees]

On the Manage Retirees page:

  1. Select the Download Retiree Response Files link.

     Select [Download Retiree Response Files]

The Electronic Protected Health Agreement opens in a new window.

  1. Select I Accept to proceed to the Download Covered Retiree List page or select Cancel to return to the Manage Retirees page.

     Select [I Accept]

On the Download Retiree Response Files page:

  1. Select a file name to download.

     Select [File name to download]

The File Download window displays showing the progress of the download.

Depending on the browser settings, the file download window may close automatically when the download is complete or you may need to close it manually.

  1. You may now download another file or select Return to Manage Retirees.

     Emphasis [File Download window]

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