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Retiree Files Sent to CMS' RDS Center

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Retiree Management

Retiree files must be sent to CMS' RDS Center throughout the Application Lifecycle to establish and maintain Qualifying Covered Retirees (QCRs) for an application. Several methods of submission are available for exchanging retiree information with CMS' RDS Center, with options to send copies of the files to the RDS Secure Website.

Review this section to learn about:

Retiree List Submission Methods and Retiree List Response Methods

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:

  • 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

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Exchanging and Protecting Retiree Information

CMS' RDS Center uses the current Retiree Electronic Data Interchange (EDI) Methods and Sources to determine which file transfer method to use to send the Weekly Notification File to the Plan Sponsor. If the retiree information does not match the source and data exchange method chosen by the Plan Sponsor for each Benefit Option, it is not processed.

If the RDS Secure Website to RDS Center submission method is specified by the Plan Sponsor, only the Authorized Representative, the Account Manager, and Designee with View/Send/Receive Retiree Data privilege may upload retiree data on the RDS Secure Website and view response files sent to the RDS Secure Website. Retiree data sent by any other method is not processed and a response file is sent back to the source with the appropriate reason code.

If a method of submission other than RDS Secure Website is specified by the Plan Sponsor, the RDS Secure Website prevents the upload of retiree data. Retiree data sent by any other source (Plan Sponsor, Vendor, or COB contractor) is not processed and a response file is sent back to the source with the appropriate reason code.

Weekly Notifications are sent to the RDS Secure Website if the Plan Sponsor specifies the RDS Secure Website as the Weekly Notification File Delivery Method or chooses to copy the RDS Secure Website for Weekly Notifications. Weekly Notifications are only sent to Vendors, COB contractors, or the Plan Sponsor's Mainframe if the most current retiree data was received and processed from that source and the Plan Sponsor's current EDI method election specifies that source and data exchange method.

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Valid Initial Retiree List

The Valid Initial Retiree List is the first transfer of retiree information from the Plan Sponsor to CMS' RDS Center. The Valid Initial Retiree List is a collection of data about the beneficiaries for whom the Plan Sponsor is seeking subsidy.

A Valid Initial Retiree List can be submitted to CMS' RDS Center after an application has been started and an Application ID has been assigned in Step 1, Benefit Options have been established in Step 2, and the Retiree Electronic Data Interchange (EDI) Methods and Sources in Step 7 have been selected.

A Valid Initial Retiree List and subsequent retiree files are exchanged using the selected Retiree EDI Method chosen for the Benefit Option. In the Valid Initial Retiree List, each beneficiary (retiree, spouse, or dependant) should have at least one detail record or row in this file. If a beneficiary has more than one coverage period or Benefit Option within the Plan Sponsor's drug plan, a record must be sent for each Benefit Option and coverage period combination.

The Valid Initial Retiree List should include the retiree information available to date. If there is outstanding retiree information that prohibits sending a beneficiary with the Valid Initial Retiree List, the beneficiary's information can be sent at a later time in a Monthly Retiree List.

A Retiree Response File is sent by CMS' RDS Center in response to the Valid Initial Retiree List submitted by the Plan Sponsor.

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Monthly Retiree List

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.

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Upload Retiree Files on the RDS Secure Website

The Valid Initial Retiree List and Monthly Retiree Lists may be uploaded to CMS' RDS Center using the Upload Retiree File page on the RDS Secure Website. If any Benefit Option contained in the retiree file is set to a submission method other than the RDS Secure Website, the RDS Secure Website will prohibit upload of the entire file.

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Display List of Uploaded Retiree Files

Use the Display List of Uploaded Retiree Files link located on the RDS Secure Website Manage Retirees page to display the successfully uploaded Valid Initial Retiree List and Monthly Retiree List files.

A retiree file does not appear in the list if:

  • Retiree files were submitted to CMS' RDS Center by Mainframe, COB:VDSA, or COB:MIR
  • Retiree files had errors during the upload

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Send Retiree Files by Mainframe or COB

The Valid Initial Retiree List and Monthly Retiree List files may be sent to CMS' RDS Center using a Vendor Mainframe connection to the RDS Center Mainframe, or a Coordination of Benefits (COB): Voluntary Data Sharing Agreement (VDSA) or Mandatory Insurer Reporting (MIR), or using a Plan Sponsor Mainframe connection to the RDS Center Mainframe.

If a retiree file is submitted using Vendor Mainframe to RDS Center Mainframe or Plan Sponsor Mainframe to RDS Center Mainframe and only contains records with a Benefit Option that is not set to Vendor Mainframe or Plan Sponsor Mainframe then the retiree file is not processed. Any records containing a Benefit Option that does not match the Mainframe method or source is returned with a Reason Code 29: File Rejected - No Authority. If the retiree file contains some records with a Benefit Option that is not set to Vendor Mainframe or Plan Sponsor Mainframe, then the retiree file is processed and any records containing a Benefit Option that does not match the Mainframe method or source is returned with a Reason Code 29: File Rejected - No Authority.

If a retiree file is submitted using Coordination of Benefits (COB): Voluntary Data Sharing Agreement (VDSA) or Mandatory Insurer Reporting (MIR) and contains records with a Benefit Option that is not set to Coordination of Benefits (COB): Voluntary Data Sharing Agreement (VDSA) or Mandatory Insurer Reporting (MIR) then the retiree file is processed. Any records containing a Benefit Option that does not match the Coordination of Benefits (COB): Voluntary Data Sharing Agreement (VDSA) or Mandatory Insurer Reporting (MIR) method or source is returned with a Reason Code 29: File Rejected - No Authority.

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Retiree Processing and Reconciliation

When Reconciliation Step 4: Finalize Covered Retirees is marked "Complete" or the Reconciliation Deadline has passed for that application, the Plan Sponsor is unable to upload retiree files through the RDS Secure Website. CMS' RDS Center no longer processes any retiree list submitted through the Mainframe, VDSA, or MIR when Reconciliation Step 4: Finalize Covered Retirees is marked "Complete" or the Reconciliation Deadline has passed for that application.

Note: CMS' RDS Center will continue to send Retiree Response Files for every retiree file that is received even after Step 4: Finalize Covered Retirees is marked "Complete." However, retiree files are not processed after Step 4 is completed. Weekly Notification Files are not sent after Step 4 is marked complete.

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