Response Files: When a Plan Sponsor submits a Valid Initial Retiree List or Monthly Retiree List for an RDS application, CMS' RDS Center verifies the Medicare entitlement for each beneficiary by checking the Medicare Beneficiary Database (MBD) system of record for this information. CMS' RDS Center sends a Retiree Response File that includes a record for each Qualifying Covered Retiree (QCR) sent in the retiree list indicating the period of time during the plan year that the Plan Sponsor may claim subsidy.
The Retiree Response File records contain all the original fields sent by the Plan Sponsor, plus the Determination Indicator, Subsidy Dates, and Reason Codes. The Retiree Response File may contain multiple responses (records) for a single beneficiary in the event that there is a gap in subsidy based on Medicare entitlement. Retiree response records should be reviewed and processed as soon as possible to assure accurate cost reporting. Response records containing Reason Codes may require research. Reason Codes are identification numbers that correspond to a specific message about a record in a response file. For a list of Reason Codes, refer to RDS Reason Codes.
Notification Files: When there is an event that may impact a Plan Sponsor's ability to receive subsidy for a beneficiary, CMS' RDS Center is notified by Medicare. When CMS' RDS Center receives notifications from Medicare, the system re-evaluates the beneficiary's eligibility for subsidy. Events that may affect a Plan Sponsor's ability to receive subsidy payments for a beneficiary include, but are not limited to: a change in Medicare entitlement, the death of a beneficiary, disenrollment, enrollment, or attempted enrollment into a Medicare Part D plan.
CMS' RDS Center conveys notifications and any resulting changes in approved subsidy periods to Plan Sponsors using Weekly Notification Files that are sent once a week when beneficiaries covered under the application have a notification event. The Weekly Notification Files contain all the original data elements that the Plan Sponsor sent in the most recent Monthly Retiree List, plus the Determination Indicator, Reason Codes, Subsidy Period Effective Date, and the Subsidy Period Termination Date. The transaction type data element will be left blank. CMS' RDS Center only sends a notification for retirees who have ever qualified for an RDS Subsidy Period. A notification record is not generated if the retiree never qualified for the RDS subsidy (regardless of the reason).