File Format for QAR Cost Reporting Exception Detail Report

Field #

Field

Sample Data

Description

1

Recipient

ABC Healthcare

Name of Vendor or Plan Sponsor recipient

2

Recipient Role

Account Manager

Role of person as assigned by the RDS Secure Website

3

Recipient Vendor

John Fakename

Name of individual associated with Vendor

4

Plan Sponsor ID

999999

A unique number assigned to a Plan Sponsor for the
duration of their participation in the RDS Program

5

Organization Name

Fake Technology Company

The legal entity name of the Plan Sponsor

6

Application ID

84361

A unique number assigned to an Application that does not change

7

Unique Benefit Option Identifier

00ABC2002

A unique identifier for each Benefit Option on the Application

8

UBOI Eligible Retiree Count

14

Unique number of eligible retirees associated with the Benefit Option

9

UBOI Monthly Eligible Retiree Count

10

Unique number of eligible retirees for the reported month

10

Cost Reporter Type

A01

Vendor Identifier or the text "Plan Sponsor"

11

File Receipt Date/Time

2010-02-04 12:12:07

Date and time that the file was received by CMS' RDS Center

12

File Processed Date

2010-02-05

Date the file was processed by CMS' RDS Center

13

Plan Month

201002

Reported month and year with error in the Cost Report

14

Exception Type

Warning

Indicates "Error" or "Warning"

15

Exception Code

110

Numeric value of Exception Code

16

Exception

Connect:Direct edits, Payment setup is
not complete for the Application

Text description of Exception Code in the Cost Report