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Troubleshooting Exchanging Retiree Information With CMS' RDS Center

User Roles:

AM

AR

D

Program Components:

Retiree Management

This section contains some tips and tricks to assist in solving some of the most commonly encountered retiree problems:

Introduction to Troubleshooting

CMS' RDS Center requests that you review and process response files and notification files in the order in which they are received as soon as possible so internal records reflect the correct Qualifying Covered Retiree (QCR) information and associated Subsidy Periods.

For more information about reason codes, refer to RDS Reason Codes.

For further guidance, refer to the Retiree Electronic Data Interchange (EDI) Methods and Sources Job Aid.

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Troubleshooting Retiree File Submission

General Troubleshooting For RDS Secure Website Retiree Files

Save the retiree file on a local drive (for example, C:\) and not on your network. Uploading files from the network can be slow and may cause the RDS Secure Website to time out.

If the file takes more than five minutes to upload, stop or cancel the upload process and try again.

For more information about retiree file upload errors, refer to Retiree File Upload Errors.

General Troubleshooting for a Connect:Direct Retiree File That Was Rejected for Errors

If the retiree file did not pass the first level of edits because errors were found in the Header Record, Detail Record, and/or Trailer Record, you will not receive a Retiree Response File. CMS' RDS Center does not send a Retiree Response File for a rejected retiree file that does not pass first level editing.

If the retiree file passes the first level of edits, but CMS' RDS Center finds errors with particular data elements (invalid Application ID, Unique Benefit Option Identifier (UBOI), Social Security Number (SSN) or Medicare beneficiary identifier (MBI, HICN, RRB), incorrectly formatted data elements, etc.) you will receive a Retiree Response File with Reason Codes. CMS' RDS Center needs you to research the data elements and corresponding Reason Code. It is important that the data elements provided in the retiree file, such as Date of Birth, Gender, SSN or Medicare beneficiary identifier (MBI, HICN, RRB), and UBOI are accurate.

The retiree file must reference the UBOI exactly as it is entered on the application. If CMS' RDS Center cannot find a match on any of the UBOIs entered on the retiree file to any UBOI on the application, the entire retiree file will be rejected. Therefore, if any data element is entered incorrectly, correct and re-submit the retiree data in the next Monthly Retiree List. If subsidy is being requested for the spouse or dependent of a Qualifying Covered Retiree, make sure the information provided in this record is the spouse's or dependent's, not that of the retiree.

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Troubleshooting Retiree Response Files and Weekly Notification Files

No beneficiaries were approved for subsidy:

Verify that the information was entered correctly. In many cases, files with no valid QCRs have an invalid Application ID, invalid Unique Benefit Option Identifier (UBOI), or some basic formatting problem.

The Valid Initial Retiree List and Monthly Retiree List must reference the UBOI exactly as it is entered on the application. If CMS' RDS Center cannot find a match on any of the UBOIs entered on the retiree file to any UBOI on the application, the entire retiree file will be rejected.

If incorrect information was entered, correct and re-submit the retiree list.

If the information was entered correctly, research the reason codes associated with the denied records.

Reason Code 12 and the Subsidy Period Termination Date is the end of the month:

The beneficiary is deceased. Some of the retirees have been assigned a future Date of Death. This is not an error.

The default Date of Death, which is the last day of the month, will automatically be reported in situations where the Social Security Administration (SSA) was notified of the retiree's death, but did not receive official confirmation (for example, a copy of the Death Certificate).

When SSA receives official confirmation of the retiree's Date of Death, the following will occur:

  1. SSA will update Medicare Beneficiary Database (MBD) with the actual Date of Death. This date will replace the future Date of Death (the last day of the month), which previously had been reported.
  2. MBD will notify CMS' RDS Center with the official Date of Death.
  3. CMS' RDS Center will send notification with the retiree's official Date of Death as the Subsidy Termination Date in the next Weekly Notification File.

Reason Code 16 - "Not A Valid Medicare Beneficiary":

Research the data elements provided in the retiree file, such as Date of Birth, Gender, and SSN or Medicare beneficiary identifier (MBI, HICN, RRB), to ensure the information provided is accurate. If any data element is entered incorrectly, correct and re-submit the retiree data in the next Monthly Retiree List.

If subsidy is being requested for the spouse or dependent of a Qualifying Covered Retiree (QCR), make sure the information provided in this record is the spouse or dependent and not that of the retiree.

If the issue persists, contact the beneficiary and 1-800-Medicare to address any discrepancies in data.

Understanding Delete Transaction Determination Indicators and Reason Codes:

Retiree Delete Transaction returns a Determination Indicator of ‘Y:

  • A delete transaction was sent in the last Monthly Retiree List requesting CMS' RDS Center to delete a record and CMS' RDS Center accepted the transaction.
  • The ‘Y’ indicates the delete was successful and the Subsidy Dates match the Plan Sponsor's Coverage Dates.

Retiree Delete Transaction returns a Determination Indicator of ‘N and Reason Code 17:

  • CMS' RDS Center rejected the delete transaction.
  • No coverage period exists for delete transaction.

Plan Sponsor has questions regarding a specific retiree's response information sent from CMS' RDS Center:

If you have a question about the retiree response information returned from CMS' RDS Center, and you believe the information you submitted is correct, resend the information in the next Monthly Retiree List.

If the retiree was originally denied the subsidy, send the retiree record as an 'ADD'.

If the retiree was accepted for the subsidy, but not for the date ranges you originally intended, send the retiree record as an 'UPD'.

If after the second submission you still have a question, contact CMS' RDS Center for assistance.

If after re-submitting a previously rejected retiree, CMS' RDS Center issues a second rejection and you still do not feel that the decision is correct, contact CMS' RDS Center and report the discrepancy. CMS' RDS Center will research the determinations as necessary and advise you accordingly. As CMS' RDS Center researches the discrepancy, it is recommended that you continue to re-submit the retirees on a Monthly Retiree List.

If CMS' RDS Center rejects one of the retirees, verify that the retiree's information was entered correctly. If incorrect information was entered, change the information accordingly and re-submit in the next Monthly Retiree List.

Retiree Response Files are expected and cannot be found on the RDS Secure Website (RDS Secure Website Only):

If you have uploaded the Valid Initial Retiree List to the RDS Secure Website but have not submitted the application, the retiree file has not yet been processed. Retiree file processing only begins once you submit a timely application.

If you have submitted the application and uploaded the Valid Initial Retiree List, or sent a Monthly Retiree List but you have not received the email indicating final approval, the Retiree Response File is not available for download. The Retiree Response File should be available for download within two business days of receiving the final approval. If more than two business days have passed, contact CMS' RDS Center for more information.

The Monthly Retiree List should be posted on the RDS Secure Website approximately three to five days after submission. If these timeframes have passed and you do not yet have the Retiree Response File, contact CMS' RDS Center for more information.

No Weekly Notification Files are received:

Reasons that this could occur are:

None of the beneficiaries covered under that application had notification events. Events may include, but are not limited to: a change in Medicare entitlement, the death of beneficiary, or enrollment in Medicare Part D.

Check the current Retiree Electronic Data Interchange (EDI) Methods and Sources to determine which file transfer method to use to send the Weekly Notification Files.

Changing the Retiree Electronic Data Interchange (EDI) Methods and Sources to Connect:Direct without fully testing it first may result in files not being received. You should not change the method until you know that the Connect:Direct connection is working properly.

When Reconciliation Step 4: Finalize Covered Retirees is marked "Complete" or the Reconciliation Deadline has passed for that application, CMS' RDS Center will no longer create or send Weekly Notification Files.

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Troubleshooting Requesting and Downloading Covered Retiree Lists

Covered Retiree List (CRL) is not posted on the RDS Secure Website:

The request may still be processing at CMS' RDS Center. The CRL should be available for download within approximately 15 minutes after the request for the list is made.

If more than 15 minutes have passed, the Plan Sponsor should check the retiree counts for the Application to verify that they are not equal to zero. For more information about viewing retiree counts, refer to Current Covered Retiree Counts.

If retiree counts are greater than zero for this application and a file is not available within approximately 15 minutes, contact CMS' RDS Center for more information.

If there are no valid retirees on the Covered Retiree List:

Verify that the information in the last submitted Monthly Retiree List was entered correctly.

If incorrect information was entered, change the information accordingly and resubmit in the next Monthly Retiree List.

If the Retiree Response File indicates that no Subsidy Periods have been approved for the beneficiaries on this application, contact CMS' RDS Center for more information.

Covered Retiree List does not match the Plan Sponsor's expected results:

If a retiree record that was expected to be on this list is absent, or if any of the Subsidy Periods do not match the Plan Sponsor's internal records, the Plan Sponsor should begin by ensuring that they have processed all of the Retiree Response Files and Weekly Notification Files for this application in the order they were received. After all files have been processed the Plan Sponsor should compare their updated internal records to the CRL.

Submit a Monthly Retiree List containing records for the beneficiaries in question when one of the following occurs:

  • The Plan Sponsor's internal records still indicate that the beneficiaries not appearing on the CRL have approved Subsidy Periods under this application.
  • The Plan Sponsor's internal records still indicate that the beneficiaries have different approved Subsidy Periods under this application.
  • The Plan Sponsor is unable to process the Retiree Response File and Weekly Notification File for any reason.

If the above actions do not resolve the discrepancies, the Plan Sponsor should work with the beneficiary to validate all identifying information (for example, Date of Birth, SSN or Medicare beneficiary identifier (MBI, HICN, RRB)) and Medicare coverage. The beneficiary may contact 1-800-Medicare to discuss any identifying information or coverage issues. If the Plan Sponsor is still unable to resolve the discrepancy, contact CMS' RDS Center for assistance.

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Troubleshooting Medicare Part D Enrollment Rejection Notifications

If no notifications are available: If there are no beneficiaries for whom the Plan Sponsor is requesting subsidy, attempting to enroll in Medicare Part D, there will be no notifications. Additionally, notifications will only remain on this page for 30 days. You will also receive these notifications as part of the Weekly Notification File.

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