Understanding Quick Access Reports

User Roles:

AM

AR

D

V

Cost Reporting Summary Report

The Cost Reporting Summary Report displays all Applications by Benefit Option that are within 90 days of their Reconciliation Deadline.

For Vendors, the Cost Reporting Summary Report lists a row for each Benefit Option a Plan Sponsor has designated the Vendor as a Cost Reporter. When the Vendor submits a Mainframe Cost Report for a Benefit Option the Vendor is not listed as a Cost Reporter, limited Application and Benefit Option data appears on the Cost Report Summary. For more information about the Vendor's Cost Report, go to: Cost Reporting Exception Detail Report.

For individual Cost Reporter Designees, a row displays for each Application Benefit Option the Plan Sponsor has designated the person as a Cost Reporter for the Plan Sponsor.

An Application no longer appears in the Cost Reporting Summary Report after more than 90 days have passed since the Reconciliation Deadline. If any activity occurs on an Application that changes the Reconciliation Deadline, for example, an Appeal, the Application appears in the Cost Reporting Summary Report.

For more information, go to: File Format for QAR Cost Reporting Summary Report for a sample file format layout of the report.

Cost Reporting Summary Report Categories

The Cost Reporting Summary Report is divided into the following categories:

  • Report Recipient
  • Alerts (Go to: QAR Alerts Glossary for a comprehensive listing of Alerts)
  • Plan Sponsor
  • Application
  • Retiree Submission and Management
  • Cost Report Submission
  • Reconciliation
  • Benefit Option
  • Cost Reporter

Field Definitions for Cost Reporting Summary Report

Report Recipient

  1. Recipient – The name of the individual Designee or Vendor Composite Report Recipient.
  2. Recipient Role – Role of person receiving the report as assigned by the RDS Secure Website.
  3. Recipient Vendor – Name of the Vendor if the recipient is a Vendor Composite Report Recipient.

Alerts

  1. Cost Reporting Alert – Numeric value of Alert.
  2. Cost Reporting Alert Description – Text description of Alert.

Plan Sponsor

  1. Plan Sponsor ID – A unique number assigned to a Plan Sponsor for the duration of their participation in the RDS Program.
  2. Organization Name – The legal entity name of the Plan Sponsor.
  3. Account Manager Name – The name of the Account Manager associated with the Plan Sponsor.
  4. Authorized Representative Name – The name of the Authorized Representative associated with the Plan Sponsor.
  5. Authorized Representative Verification Status – The status of the Authorized Representative.

Application

  1. Application ID – A unique number assigned to an Application that does not change.  
  2. Plan Name – The name of the Plan associated with the Application.
  3. Plan Year Start Date – The beginning date defining the Plan Year. The Plan Year defines the retiree coverage periods for subsidy. Costs are reported by Plan Month.
  4. Plan Year End Date – The end date of the Plan Year. The Plan Year defines the retiree coverage periods for subsidy. Costs are reported by Plan Month.
  5. Application Status – The current status of the Application.

    Valid Statuses:

    1. Submitted
    2. Approved
    3. Reconciliation Initiated
    4. Reconciliation Cost Reporting Opened
    5. Reconciliation Cost Reporting Closed
    6. Reconciliation Request Completed
    7. Denied
    8. Withdrawn
    9. Incomplete
    10. Application  Error
    11. Reconsideration  Requested
    12. Reopening Requested
    13. Appeal Under Review
    14. Re-sign Application
    15. EFT Re-sign Application
  6. Application Status Date – The date associated with the latest Application Status change.
  7. Interim Payment Frequency – Denotes how frequently the Plan Sponsor can request payment on the Application.

    Valid Values:

    1. Monthly (allows twelve interim payment requests)
    2. Quarterly (allows four interim payment requests)
    3. Interim Annual (allows one interim payment request)
    4.  Annual (allows for no interim payment requests. A single annual payment can be requested through the Reconciliation process)
  8. Total Paid To Date – Total dollar amount of the Automated Clearing House (ACH) payments for the Application.

Retiree Submission and Management

  1. Retiree Submissions Ready – An indicator of whether retiree files are accepted or rejected by CMS’ RDS Center. This is a variable, derived field that is generated from current Application conditions and provides an informative analysis of these conditions.

    Valid Values:

    1. Open (submitted retiree files for the Application accepted by CMS’ RDS Center)
    2. Closed (submitted retiree files for the Application not processed by CMS’ RDS Center)
  2. Retiree List Submission Method – The method by which retiree data is submitted to CMS' RDS Center for the Benefit Option. This is defined during the Application process.
  3. Submitter ID – The Submitter ID associated to the Vendor, Plan Sponsor, Voluntary Data Sharing Agreement (VDSA), or Mandatory Insurer Reporting (MIR), who submits retiree files for the Benefit Option. “RDS Secure Website” is listed if the Plan Sponsor has chosen the RDS Secure Website as the submission method for retiree files.
  4. Submitter Name – The Submitter name associated to the Vendor, Plan Sponsor, VDSA, or MIR. “RDS Secure Website” is listed if the Plan Sponsor has chosen the RDS Secure Website as the submission method for retiree files.
  5. Retiree List Response Method – The method by which retiree data is communicated to the Submitter or Plan Sponsor.
  6. Weekly Notification File Delivery Method – The delivery method for notifications from CMS’ RDS Center concerning Qualifying Covered Retirees.
  7. Last Covered Retiree List Created Date – The last date that a Covered Retiree List was generated for the Application.

Cost Report Submission

  1. Payment Setup Complete – A Yes/No indicator that all steps of Payment Setup are complete. Cost Reports are not accepted by CMS' RDS Center when Payment Setup is incomplete. This is a variable, derived field that is generated from current Application conditions and provides an informative analysis of these conditions.
  2. Cost Report Ready – Indicates whether Cost Reports are ready to be accepted by CMS’ RDS Center. This is a variable, derived field that is generated from current Application conditions and provides an informative analysis of these conditions.

    Valid Values:

    1. Interim Open
    2. Interim Temporarily Closed (includes the reason why Cost Reporting is closed)
    3. Interim Closed (includes the reason why Cost Reporting is closed)
    4. Final Open
    5. Final Temporarily Closed (includes the reason why Cost Reporting is closed)
    6. Final Closed (includes the reason why Cost Reporting is closed)
    7. Cost Reporting Closed (includes the reason why Cost Reporting is closed)

Reconciliation

  1. Reconciliation Deadline Date – The date Reconciliation must be completed by the Plan Sponsor to avoid an overpayment.
  2. Last Completed Recon Step – The Reconciliation step last completed by the Plan Sponsor.
  3. Recon Step Date/Time – The date and time the Plan Sponsor completed the last Reconciliation step.

Benefit Option

  1. Benefit Option Name – A Benefit Option is a particular benefit design, category of benefits, or cost-sharing arrangement offered within a group health plan. The Benefit Option name is chosen by the Plan Sponsor.
  2. Unique Benefit Option Identifier – A unique identifier for each Benefit Option on the Application; also known as the Rx Group number.
  3. UBOI Eligible Retiree Count – The unique number of eligible retirees associated with the Benefit Option.
  4. Multiple Cost Reporters Assigned – A Yes/No indicator that multiple sources have been assigned to report costs for the Benefit Option. This is a variable, derived field that is generated from current Application conditions and provides an informative analysis of these conditions.
  5. Costs Accepted From Another Reporting Source – Indicates if Benefit Option costs greater than zero have been reported and accepted from another Cost Reporting source.

Cost Reporter

  1. Cost Reporter Type – If a Vendor is assigned as a Cost Reporter for the UBOI, this field displays the unique Vendor Identifier assigned by CMS' RDS Center. If the Plan Sponsor is assigned as a Cost Reporter for the UBOI, this field displays the text "Plan Sponsor". This is a variable, derived field that is generated from current Application conditions and provides an informative analysis of these conditions.
  2. Last Cost Report Accepted File Receipt Date/Time – The file receipt date and time associated with the last Cost Report for the Benefit Option that was accepted by CMS’ RDS Center. The field is only populated for Mainframe reports.
  3. Last Cost Report Accepted Processed Date – The date a Cost Report submitted by the Cost Reporter was last accepted by CMS' RDS Center for the given UBOI.
  4. Last Cost Report Accepted Status – The most current status associated with most recently accepted Cost Report.

    Valid Values:

    1. Data Entry: Saved
    2. Data Entry: Submitted
    3. Mainframe: Submitted
    4. Included In Payment Request
    5. Included in Final Reconciliation
    6. Data Entry: Update/Entry Required
    7. Review Complete: Accepted
    8. Review Complete: Rejected
    9. Reviewed
  5. Last Cost Report Accepted Status Date – The date associated with the Last Cost Report Accepted Status.
  6. Last Cost Report Accepted Type – The timing of the most recently accepted Cost Report.

    Valid Values:

    1. Interim
    2. Final
  7. Last Cost Report Accepted Allowable Retiree Cost – The total Allowable Retiree Costs submitted for the Benefit Option included in the most recently accepted Cost Report.
  8. Last Cost Report Rejected File Receipt Date/Time – This is the file receipt date and time associated with the last Cost Report for the Benefit Option that was rejected by CMS’ RDS Center.
  9. Last Cost Report Rejected File Processed Date – This is the date a Mainframe Cost Report submitted by the Cost Reporter was last rejected by CMS' RDS Center for the given UBOI.
  10. Last Cost Report Rejected Status – Indicates that errors were detected in a Mainframe Cost Report.

    Valid Value:

    1. Mainframe: Errors Detected
  1. Last Cost Report Rejected Type – The timing of the most recently rejected Cost Report.

    Valid Values:

    1. Interim
    2. Final
  2. Last Cost Report Rejected Allowable Retiree Cost – The total Allowable Retiree Costs for the Benefit Option included in the last Cost Report rejected by CMS' RDS Center.

Cost Reporting Exception Detail Report

The Cost Reporting Exception Detail Report displays warning and errors detected on Mainframe Cost Reports submitted by the Vendor. Details are provided for the last rejected Mainframe Cost Report submitted for a Benefit Option within the last 45 days. Go to: File Format for QAR Cost Reporting Exception Detail Report for a sample file format layout of the report.

Field Definitions for Cost Reporting Exception Detail Report

  1. Recipient – The name of the Vendor or Plan Sponsor recipient.
  2. Recipient Role – The role of the person as assigned by the RDS Secure Website.
  3. Recipient Vendor – The name of the Vendor (if the recipient is a Vendor Composite Report Recipient).
  4. Plan Sponsor ID – The unique number assigned to a Plan Sponsor for the duration of their participation in the RDS Program.
  5. Organization Name – The legal entity name of the Plan Sponsor.
  6. Application ID – A unique number assigned to an Application that does not change. 
  7. Unique Benefit Option Identifier – A unique identifier for each Benefit Option on the Application; also known as the Rx Group number. 
  8. UBOI Eligible Retiree Count – The unique number of eligible retirees associated with the Benefit Option.
  9. UBOI Monthly Eligible Retiree Count – The unique number of eligible retirees associated with the Benefit Option for the reporting month.
  10. Cost Reporter Type – If a Vendor is assigned as a Cost Reporter for the UBOI, this field displays the unique Vendor Identifier assigned by CMS' RDS Center. If the Plan Sponsor is assigned as a Cost Reporter for the UBOI, this field displays the text "Plan Sponsor". 
  11. File Receipt Date/Time – The date and time that the file was received by CMS’ RDS Center.
  12. File Processed Date – The date the Cost Report file was processed by CMS' RDS Center.
  13. Plan Month – Reported month and year receiving the Error or Warning.
  14. Exception Type – Indicator of whether the Exception is an Error or Warning.
  15. Exception Code – The numeric value of the Exception.
  16. Exception – Text description of the Exception Code in the Cost Report.

File Extraction, Receiving Files, or Data Assistance

For assistance with any file extraction, file delivery, or data issues, contact CMS’ RDS Center