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RDS Program Components

Additional Program Tasks

Quick Access Reports (QAR)

Supplemental Information

RDS Reason Codes

User Roles:

AM

AR

D

V

Program Components:

Retiree Management

Reason codes are identification numbers that correspond to a specific message about a record in a response file or a notification file.

Note: If a change in eligibility creates a gap in the subsidy coverage period or a beneficiary is enrolled in more than one Benefit Option for an application, you will receive more than one record for the beneficiary.

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

RDS Reason Codes
Reason Code Title File Type Determination Indicator What It Means What You Should Do
00 Coverage Dates Accepted Response File Only Y The row has been accepted by CMS' RDS Center. No Action Required.
01 Missed Application Deadline Response File Only Blank The Plan Sponsor did not meet Application Deadline requirements as specified in 42 C.F.R. §423.884(c). Do not send retiree files for this application.
02 Invalid Application Number Response File Only Blank Invalid Application Number: The Application ID in the record you sent is not a valid Application in the RDS System. Ensure the Application ID is submitted EXACTLY as it appears on the RDS Secure Website.
03 Invalid Last Name Response File Only Blank Invalid Last Name.
The field contains spaces or is numeric.
Verify the Last Name field does not contain spaces or numbers.
04 Invalid First Name Response File Only Blank Invalid First Name.
The field contains spaces or is numeric.
Verify the First Name field does not contain spaces or numbers.
05 Invalid Date of Birth Response File Only Blank Invalid Date of Birth.
The date must be a valid date in CCYYMMDD format.
Verify the Date of Birth is formatted correctly.
06 Invalid Gender Response File Only Blank Invalid Gender.
The gender must be:
Value '0' = Gender Unknown
Value '1' = Male
Value '2' = Female
Verify the Gender submitted matches one of the valid values.
07 Invalid Coverage Effective Date Response File Only Blank Invalid Coverage Effective Date.
The Coverage Effective Date must be a valid date in CCYYMMDD format.
Verify the Coverage Effective Date is formatted properly.
08 Invalid Coverage Termination Date Response File Only Blank Invalid Coverage Termination Date.
The Coverage Termination Date must be a valid date in CCYYMMDD format.
Verify the Coverage Termination Date is formatted properly.
09 Invalid Unique Benefit Option Identifier Response File Only Blank Invalid Unique Benefit Option Identifier.
You have submitted a retiree file with a UBOI that does not precisely reflect the UBOI on the application specified in this retiree file.
Verify that the UBOI is typed exactly as it appears on the Application Status page.
10 Enrolled in Medicare Part D Response File Y The QCR is enrolled in Medicare Part D for some portion of the Subsidy Period for which you have applied. Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the QCR for subsidy.
10 Enrolled in Medicare Part D Response File N The beneficiary is not eligible for subsidy because they are enrolled in Medicare Part D during the entire period for which you requested coverage. You may contact the beneficiary to discuss their Medicare Part D enrollment.
10 Enrolled in Medicare Part D Notification File Y The QCR is enrolled in Medicare Part D for some portion of the Subsidy Period that was previously approved. Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the QCR for subsidy. Internal records should be adjusted to ensure that costs are appropriately calculated.
10 Enrolled in Medicare Part D Notification File N This beneficiary is no longer eligible for subsidy because of enrollment in Medicare Part D during the entire Subsidy Period that was previously approved. Internal records should be adjusted to ensure that costs are appropriately calculated.
10 Enrolled in Medicare Part D Covered Retiree List Y The QCR is enrolled in Medicare Part D for some portion of the period of RDS coverage for which you previously applied or were approved. Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the beneficiary for the subsidy.
11 Not eligible for Medicare Part D Response File Y The QCR is not eligible for Medicare for some portion of the Subsidy Period for which you have applied. Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the QCR for subsidy.
11 Not eligible for Medicare Part D Response File N This beneficiary is not eligible for Medicare for the entire Subsidy Period for which you have applied. You may wish to contact the beneficiary to discuss their Medicare Part entitlement and enrollment.
11 Not eligible for Medicare Part D Notification File Y The QCR is not eligible for Medicare for some portion of the Subsidy Period for which they were previously approved. Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the QCR for subsidy. Update your internal records to reflect the change in subsidy.
11 Not eligible for Medicare Part D Notification File N The beneficiary is not eligible for Medicare Part D for the entire Subsidy Period for which they were previously approved. This beneficiary is not eligible for subsidy because of they are not eligible for Medicare during the entire Subsidy Period that was previously approved.
11 Not eligible for Medicare Part D Covered Retiree List Y The QCR is not eligible for Medicare Part D for some portion of the period of RDS coverage for which you previously applied or were approved. Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the QCR for subsidy.
12 Beneficiary is deceased Response File Y The QCRs date of death falls within the Subsidy Period for which you have applied. Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the QCR for subsidy.
12 Beneficiary is deceased Response File N This beneficiary is not eligible for subsidy because their date of death is prior to the Subsidy Period for which you have applied. N/A
12 Beneficiary is deceased Notification File Y The QCR's date of death falls within the Subsidy Period for which they were previously approved. The previously approved Subsidy Period will have a new termination date. You should replace all coverage records.
12 Beneficiary is deceased: The beneficiary's date of death falls within the Subsidy Period for which you have applied. Notification File N This beneficiary is not eligible for subsidy because their date of death is prior to the Subsidy Period for which you were previously approved. You should delete all Subsidy Periods.
12 Beneficiary is deceased: The beneficiary's date of death falls within the Subsidy Period for which you have applied. Covered Retiree List Y The QCR's date of death falls within the period of RDS coverage for which you previously applied or were approved. Refer to the Subsidy Period Effective Date and Subsidy Period Termination Date for the period that you may claim the beneficiary for the subsidy.
13 Medicare beneficiary identifier or SSN is invalid. Response File N

A valid Medicare beneficiary identifier (MBI, HICN, or RRB), or SSN must be provided for the individual for whom the Plan Sponsor is seeking subsidy.
Valid SSN:

  • 9 numeric characters. Do not include hyphens or other special characters.
  • Cannot contain all zeros.
  • First three digits cannot be ‘666’ or ‘900’ - ‘999’.

Valid MBI:

  • 11 alphanumeric characters.
  • Cannot begin with 0.
  • Must not start or end with two alphabetic characters.
  • Must contain no more than 2 consecutive numbers.
  • Must contain no more than 2 consecutive alphabetic characters.
  • Must not contain the alphabetic characters S, L, O, I, B, Z.
  • Must not contain lowercase letters.
  • Do not include hyphens or other special characters.

Valid HICN:

  • Valid HICN consists of a SSN followed by an alpha or alphanumeric Beneficiary Identification Code (BIC)
  • Characters 1-3 cannot be ‘000’, ‘666’, or ‘990’ – ‘999’.
  • Characters 4-5 cannot be ‘00’.
  • Bytes 6-9 cannot be ‘0000’.
  • Character 10 must be a letter.
  • Character 11 is dependent on character 10 (can be space, letter, or number).
  • Must not contain lowercase letters.
  • Do not include hyphens or other special characters.

Valid RRB:

  • Up to 12 alphanumeric characters
  • 6 or 9 numeric characters preceded by one or more uppercase alpha characters.
Verify that the Medicare beneficiary identifier and SSN have been entered correctly.
14 Termination Date is less than Effective Date Response File N The Coverage Termination Date you sent for this beneficiary is earlier than the Coverage Effective Date. Verify the Coverage Termination Date.
15 Error occurred in header or trailer Response File N Mainframe or Connect: Direct only. Verify header or trailer.
16 Not a valid Medicare Beneficiary Response File N This beneficiary was not found in the Medicare Beneficiary Database. For more information about Reason Code 16, refer to Troubleshooting Retiree Response Files and Weekly Notification Files.
17 No Coverage Period exists for delete transaction. Response File N CMS' RDS Center has made no update. No Action Required.
18 Invalid Action Type Response File N The action type must be: ADD, UPD, or DEL. Verify the action type is ADD, UPD, or DEL.
19 Invalid relationship code Response File N The relationship code must be:
Value '01' = Self
Value '02' = Spouse
Value '03' = Other
Verify the relationship code submitted matches one of the valid values.
20 Beneficiary attempted to enroll in Medicare Part D and received an initial rejection Notification File Only Blank Beneficiary attempted to enroll in Medicare Part D and received an initial rejection.
If the notification event is regarding the beneficiary's initial application for Medicare Part D or is a change that may result in an increased Subsidy Period, the original Subsidy Period Effective and Termination Dates will be reported in the file.
The Medicare Part D Enrollment Rejection Notification is your cue to contact the QCR who applied for Medicare Part D. You should explain to the QCR that your plan has equivalent or better drug coverage and the QCR does not need Medicare Part D. The notification is your indication that they have been initially rejected from Medicare Part D. If the QCR persists and enrolls in Medicare Part D you will no longer be allowed to receive subsidy for that individual.
There is no need to inform CMS' RDS Center of the contact with the QCR.
21 New Medicare information has been received: Resend this beneficiary's record to CMS' RDS Center. Notification File Only Blank The Determination Indicator will be blank and the subsidy dates will be set to zero. The new Medicare information may result in increased subsidy coverage. Re-submit this beneficiary in the next Monthly Retiree List.
24 Coverage Dates Outside the Plan Year Response File Only N The entire Subsidy Period you requested for the beneficiary is outside the range of the plan year for the application, or
the Subsidy Period Termination Date you requested is before January 1, 2006, the beginning of the RDS Program. 
Check to make sure the Plan Sponsor Coverage dates match the Plan Year Start and Plan Year End dates for the application you are submitting.
26 File Rejected - Denied Application Response File Blank The status of the application for which this retiree file was submitted is Denied. This retiree file was not processed by CMS' RDS Center. Do not send retiree files for this application.
26 File Rejected - Denied Application Notification File Blank This application has been denied after retirees were previously approved for subsidy. CMS' RDS Center has removed all subsidy for this application. Remove all subsidy from your records for the beneficiaries, Benefit Options, and Subsidy Periods listed in this Notification File.
Do not send retiree files for this application.
27 File Rejected - Withdrawn Application Response File Blank The status of the application for which this retiree file was submitted is Withdrawn. This retiree file was not processed by CMS' RDS Center. Do not send retiree files for this application.
27 File Rejected - Withdrawn Application Notification File Blank This application has been withdrawn after retirees were previously approved for subsidy. CMS' RDS Center has removed all subsidy for this application. Remove all subsidy from your records for the beneficiaries, Benefit Options, and Subsidy Periods listed in this notification file.
Do not send retiree files for this application.
28 File Rejected - Closed Application Response File Only Blank The application for which this retiree file was submitted is past Reconciliation Step 4: Finalize Covered Retirees or the Reconciliation Deadline has passed. This retiree file was not processed by CMS' RDS Center. Do not send retiree files for this application.
29 File Rejected - No Authority Response File Only Blank The application for which this retiree file was submitted does not allow retiree files from this source or method. This retiree file was not processed by CMS' RDS Center. Contact the Plan Sponsor associated with this application to discuss the authorized retiree list submission source and method.
30, 31 To Be Determined Response and Notification Files Blank These reason codes are reserved for future use. These will be informational only, similar to Reason Code 20. This record will not result in a subsidy change. It will likely require you to contact the specific beneficiary.
32 File Rejected - Appealed Application Response File Only Blank The application for which this retiree file was submitted is in an appeal status. This retiree file was not processed by CMS' RDS Center. Do not send retiree files for this application.
33 File Rejected - Deleted Application Response File Blank The status of the application for which this retiree file was submitted is Deleted. This retiree file was not processed by CMS' RDS Center. Do not send retiree files for this application.
33 Deleted Application Notification File Blank The Application Status was set to Deleted after retirees were previously approved for subsidy. CMS' RDS Center has removed all subsidy for this application. Remove all subsidy from your records for the Beneficiaries, Benefit Options, and Subsidy Periods listed in this notification file.
Do not send retiree files for this application.
34 File Rejected - Abandoned Application Response File Blank The status of the application for which this retiree file was submitted is Abandoned. This retiree file was not processed by CMS' RDS Center. Do not send retiree files for this application.
34 Abandoned Application Notification File Blank The Application Status was set to Abandoned after retirees were previously approved for subsidy. CMS' RDS Center has removed all subsidy for this application.
Note: Abandoned is a future application status and is not currently in use.
Remove all subsidy from your records for the Beneficiaries, Benefit Options, and Subsidy Periods listed in this notification file.
Do not send retiree files for this application.
99 Subsidy Removed Notification File Only Y or N, depending on whether part or all of the subsidy was removed CMS' RDS Center has removed all or some period of the subsidy previously approved for this Qualified Covered Retiree. CMS' RDS Center will contact you about the actions you should take prior to sending this file.

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