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RDS Program Components

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Quick Access Reports (QAR)

Supplemental Information

Retiree Response File Layouts

User Roles:

AM

AR

D

V

Program Components:

Retiree Management

The following response file layouts and copybook are available for reference:

CSV File Layout of Retiree Response Files on the RDS Secure Website

Note: Fields with a caret (^) are filled based on the information the Plan Sponsor has sent to CMS' RDS Center.

CSV File Layout of Retiree Response Files on the RDS Secure Website
Data Element Max Size Notes
^Application ID 10 The RDS Application ID that was submitted in the retiree file correlating to this Retiree Response File.
^SSN 09 Social Security Number (SSN) that was submitted for this beneficiary.This field may be blank if a Medicare beneficiary identifier was provided.
^Medicare beneficiary identifier 12 Medicare beneficiary identifier that was submitted for this beneficiary.

This field may be blank if the SSN was provided.

May contain:

  • Medicare Beneficiary Identifier (MBI) that was submitted for this beneficiary.
  • Medicare Health Insurance Claim Number (HICN) that was submitted for this beneficiary.
  • Railroad Retirement Board (RRB) number that was submitted for this beneficiary.
^First Name 30 First Name that was submitted for this beneficiary.
^Middle Initial 01 Optional field. Middle Initial that was submitted for this beneficiary.
^Last Name 40 Last Name that was submitted for this beneficiary.
^Date of Birth 08 Date of Birth that was submitted for this beneficiary. Format: CCYYMMDD
^Gender 01 Gender that was submitted for this beneficiary.
Value '0' = Gender Unknown
Value '1' = Male
Value '2' = Female
^Coverage Effective Date 08 The date that was submitted for this beneficiary's (retiree, spouse, or dependant) coverage to begin under the Plan Sponsor's prescription drug Benefit Option. Format: CCYYMMDD
^Coverage Termination Date 08 The date that was submitted for this beneficiary's (retiree, spouse, or dependant) coverage to end under the Plan Sponsor's prescription drug Benefit Option. Format: CCYYMMDD
^Unique Benefit Option Identifier 20 Unique Benefit Option Identifier (UBOI) (for example, Rx Group Number) corresponding to the benefit under which you submitted this beneficiary for subsidy.
^Relationship to Retiree 02 Relationship to retiree that was submitted for this beneficiary.
Value '01' = Self
Value '02' = Spouse
Value '03' = Other
^Transaction Type 03 Transaction type that was submitted for this beneficiary.
Value 'ADD' = Add
Value 'UPD' = Update
Value 'DEL' = Delete
Determination Indicator 01 Value 'Y' = Yes, the retiree qualifies for all or some portion of Subsidy Period for which you applied.
Value 'N' = No, the retiree does not qualify for subsidy for the entire period for which you applied.
Reason Code 02 The Reason Code provides a reason that this beneficiary was not approved or only partially approved for subsidy for which you applied. For more information, refer to RDS Reason Codes.
Subsidy Period Effective Date 08 The effective date that the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved.
For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes.
Format: CCYYMMDD
Subsidy Period Termination Date 08 The termination date that the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved.
For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes.
Format: CCYYMMDD

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Retiree Response Files Record Layout

Note: Fields with a caret (^) are filled based on the information the Plan Sponsor has sent to CMS' RDS Center.

Retiree Response Files Record Layout
Data Element Field Description Notes
Record Type PIC X(01) Value 'D' = Detail Record
^SSN PIC X(09) Social Security Number (SSN) that was submitted for this beneficiary. This field may contain spaces if a Medicare beneficiary identifier was provided.
^Medicare beneficiary identifier PIC X(12) Medicare beneficiary identifier that was submitted for this beneficiary.

This field may be blank if the SSN was provided.

May contain:

  • Medicare Beneficiary Identifier (MBI) that was submitted for this beneficiary.
  • Medicare Health Insurance Claim Number (HICN) that was submitted for this beneficiary.
  • Railroad Retirement Board (RRB) number that was submitted for this beneficiary.
^First Name PIC X(30) First Name that was submitted for this beneficiary.
Middle Initial PIC X(01) Optional field. Middle Initial that was submitted for this beneficiary.
^Last Name PIC X(40) Last Name that was submitted for this beneficiary.
^Date of Birth PIC X(08) Date of Birth that was submitted for this beneficiary. Format: CCYYMMDD
^Gender PIC X(01) Gender that was submitted for this beneficiary.
Value '0' = Gender Unknown
Value '1' = Male
Value '2' = Female
^Coverage Effective Date PIC X(08) The date that was submitted for this beneficiary's (retiree, spouse, or dependant) coverage to begin under the Plan Sponsor's Prescription Drug Benefit Option. Format: CCYYMMDD
^Coverage Termination Date PIC X(08) The date that was submitted for this beneficiary's (retiree, spouse, or dependant) coverage to end under the Plan Sponsor's Prescription Drug Benefit Option. Format: CCYYMMDD
^Unique Benefit Option Identifier PIC X(20) Unique Benefit Option Identifier (UBOI) (for example, Rx group number) corresponding to the benefit under which you submitted this beneficiary for subsidy.
^Relationship to Retiree PIC X(02) Relationship to retiree that was submitted for this beneficiary.
Value '01' = Self
Value '02' = Spouse
Value '03' = Other
^Transaction Type PIC X(03) Transaction type that was submitted for this beneficiary.
Value 'ADD' = Add
Value 'UPD' = Update
Value 'DEL' = Delete
Determination Indicator PIC X(01) Value 'Y' = Yes, the retiree qualifies for all or some portion of Subsidy Period for which you applied.
Value 'N ' = No, the retiree does not qualify for all or some portion of subsidy for which you applied.
Reason Code PIC X(02) The Reason Code provides a reason that this beneficiary was not approved or only partially approved for subsidy for which you applied. For more information, refer to RDS Reason Codes.
Subsidy Period Effective Date PIC X(08) The effective date that the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved.
For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes.
Format: CCYYMMDD
Subsidy Period Termination Date PIC X(08) The termination date that the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved.
For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes.
Format: CCYYMMDD
Filler PIC X(38) Spaces

Trailer Record

Retiree Response Files Record Layout - Trailer Record
Data Element Field Description Notes
Record Type PIC X(01) Value 'T' = Trailer Record
Application ID PIC X(10) The RDS Application ID that was submitted in the retiree file correlating to this Retiree Response File. Includes leading zeroes as needed to completely fill field.
Creation Date PIC X(08) Date the file was created. Format: CCYYMMDD
Creation Time PIC X(06) Time the file was created. Format: HHMMSS
Number of Detail Records PIC X(07) Right justified and zero filled.
Filler PIC X(168) Spaces

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Retiree Response Files Connect:Direct Record Layout

The retiree response record contains all the original fields (marked with a caret (^)) sent by the Plan Sponsor in the retiree file, plus the Determination Indicator, Subsidy Dates, and Reason Code. The Plan Sponsor may receive multiple responses (records) for a single beneficiary in the event that there is a gap in RDS Coverage Periods based on Medicare entitlement or multiple records have been submitted for the beneficiary.

For more information, refer to Connect:Direct Retiree Response File Copybook.

Header Record

Retiree Response Files Connect:Direct Record Layout - Header Record
Data Element Field Description  Notes
Record Type PIC X(01) Value 'H' = Header Record
Application ID PIC X(10) The RDS Application ID that was submitted in the retiree file correlating to this Retiree Response File. Includes leading zeroes as needed to completely fill field.
Creation Date PIC X(08) Date the file was created. Format: CCYYMMDD
Creation Time PIC X(06) Time the file was created. Format: HHMMSS
Filler PIC X(175) Spaces

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Connect:Direct Retiree Response File Copybook

* RDS RETIREE LIST HEADER FROM/TO PLAN SPONSOR
01 (*) - RETIREE-LIST-HDR (blank cell)
05 (*) - RECORD-TYPE PIC X(01)
88 (*) - HEADER VALUE 'H'
05 (*) - APPLICATION-ID PIC X(10) 
05 (*) - TRANSMIT-DATE PIC X(08)
05 (*) - TRANSMIT-TIME PIC X(06)
05 (*) - RECORD-COUNT PIC 9(07)
05 FILLER PIC X(27)
* RDS RETIREE LIST TRAILER FROM/TO PLAN SPONSOR
01 (*) - RETIREE-LIST-TRL (blank cell)
05 (*) - RECORD-TYPE PIC X(01)
88 (*) - TRAILER VALUE 'T'
05 (*) - APPLICATION-ID PIC X(10)
05 (*) - TRANSMIT-DATE PIC X(08)
05 (*) - TRANSMIT-TIME PIC X(06)
05 (*) - RECORD-COUNT PIC 9(07)
* RDS RETIREE LIST DETAIL FROM / TO PLAN SPONSOR
01 (*) - RETIREE-ENTRY (blank cell)
02 (*) - RETIREE-RECORD (blank cell)
05 (*) - RECORD-TYPE PIC X(01)
88 (*) - DETAIL VALUE 'D'
05 (*) - BENE-SSN PIC X(09)
05 (*) - BENE-MEDICARE-BENEFICIARY-IDENTIFIER PIC X(12)
05 (*) - BENE-FIRST-NAME PIC X(30)
05 (*) - BENE-INITIAL PIC X(01)
05 (*) - BENE-LAST-NAME PIC X(40)
05 (*) - BENE-BIRTH-DATE PIC X(08)
05 (*) - BENE-SEX-CODE PIC X(01)
88 (*) - SEX-UNKNOWN VALUE '0'
88 (*) - MALE VALUE '1'
88 (*) - FEMALE VALUE '2'
05 (*) - COVG-EFF-DATE PIC X(08)
05 (*) - COVG-TERM-DATE PIC X(08)
05 (*) - RX-GROUP-NUMBER PIC X(20)
05 (*) - BENE-RELATIONSHIP PIC X(02)
88 (*) - SELF VALUE '01'
88 (*) - SPOUSE VALUE '02'
88 (*) - OTHER VALUE '03'
05 (*) - RECORD-ACTION PIC X(03)
88 (*) - ADD VALUE 'ADD'
88 (*) - UPDATE VALUE 'UPD'
88 (*) - DELETE VALUE 'DEL'
02 (*) - RETIREE-RESPONSE. (blank cell)
05 (*) - RDS-SUBSIDY-SW PIC X(01)
05 (*) - RDS-DENIAL-CODE PIC X(02)
05 (*) - RDS-EFF-DATE PIC X(08)
05 (*) - RDS-TERM-DATE PIC X(08)
05 FILLER PIC X(143)
05 (*) - DCN PIC X(15)

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