User Roles Support Tool: Retiree Management

User Roles:

AM

AR

D

Program Components:

Retiree Management

Plan Sponsors may only submit interim costs for the Qualifying Covered Retirees, Benefit Options, and Subsidy Periods listed in the Covered Retiree List (CRL). Therefore, it is necessary to manage retiree information throughout the phases of an RDS application. The following identifies the actions and user roles associated with retiree management.

Note: Individuals must be authorized to view Protected Health Information (PHI) to display and download retiree data. If a Vendor is managing retirees on behalf of the Plan Sponsor, a Designee who is an employee of the Vendor may be assigned by the Account Manager or Authorized Representative to utilize these resources.

Select Electronic Data Interchange (EDI) Methods and Sources AM AR D

The Account Manager, Authorized Representative, and Designee with Choose Electronic Data Interchange (EDI) Methods and Sources privilege may select Retiree EDI Methods and Sources. The selections may vary by Benefit Option. The selections are initially made during the Application Submission Process and may be changed at any time throughout the plan year after the appropriate connection has been established and tested.

Submit Retiree Files to CMS' RDS Center AM AR D

The Account Manager, Authorized Representative, and Designee with View/Send/Receive Retiree Data privilege may submit Retiree Files to CMS' RDS Center using the RDS Secure Website for those Benefit Options assigned the RDS Secure Website EDI method and source.

Vendors and Plan Sponsors with pre-existing Mainframe connections may submit Retiree Files to CMS' RDS Center using the Mainframe method if a mainframe EDI method is chosen for the Benefit Option. The Vendor's ID must be specified for the Benefit Option.

VDSA partners submitting non-Medicare Secondary Payer (MSP) records and Mandatory Insurer Reporting (MIR) participants using the expanded implementation model may submit Retiree Files to CMS' RDS Center using the Coordination of Benefits (COB) method for those Benefit Options assigned a Coordination of Benefits EDI method.

Download and Review Response Files AM AR D

The Account Manager and Designee with View/Send/Receive Retiree Data privilege may receive an email indicating that the Retiree Response Files are available for download on the RDS Secure Website if this is the selected Retiree Electronic Data Interchange (EDI) Method.

The Account Manager, Authorized Representative, and Designee with View/Send/Receive Retiree Data privilege may download Retiree Response Files on the RDS Secure Website.

Download and Review Notification Files AM AR D

The Account Manager and Designee with View/Send/Receive Retiree Data privilege may receive an email indicating that Notification Files are available for download.

The Account Manager, Authorized Representative, and Designee with View/Send/Receive Retiree Data privilege may access the Download Weekly Notification Files page using the Manage Retirees page.

View Medicare Part D Enrollment Rejection Notifications AM AR D

The Account Manager, Authorized Representative, and Designee with View/Send/Receive Retiree Data privilege may access Medicare Part D Enrollment Rejection Notifications.

View Current Covered Retiree Counts AM AR D

The Account Manager, Authorized Representative, and Designee with View/Send/Receive Retiree Data privilege may view the Current Covered Retiree Counts.

Download, Distribute, and Scrutinize the Covered Retiree List (CRL) AM AR D

The Account Manager, Authorized Representative, and Designee with View/Send/Receive Retiree Data privilege may request and download a Covered Retiree List (CRL) from the RDS Secure Website.

Distribute the CRL to the individuals that will scrutinize the list at each Benefit Option level. This might include people who manage and process claims, as well as those who calculate and report costs. Each person should receive only the information needed. They should then carefully scrutinize the CRL. Many times the enrollment system and the claims processing system are separate. Compare the CRL against both of these systems and internal records. Reconcile any differences.