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CMS' RDS Center will be performing system maintenance on the RDS Secure Website on Friday, April 19, 2024 beginning at 9:00PM ET and concluding Saturday, April 20, 2024 at 10:00AM ET. The Secure Website will be available, but file processing will be impacted. Refer to this Announcement for details.

File Format for QAR Cost Reporting Summary Report

User Roles:

AM

AR

D

V

File Format for QAR Cost Reporting Summary Report

Field #

Field

Sample Data

Description

Derived
Field

1

Recipient

ABC Healthcare

Name of report recipient

No

2

Recipient Role

Account Manager

Role of person as assigned by the RDS Secure Website

No

3

Recipient Vendor

John Fakename

Name of individual associated with Vendor

No

4

Cost Reporting Alert

101

Numeric value of Alert

No

5

Cost Reporting Alert Description

No Reports: Interim Cost Reporting Open

Text description of Alert

No

6

Plan Sponsor ID

999999

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

No

7

Organization Name

Fake Technology Company

The legal entity name of the Plan Sponsor

No

8

Account Manager Name

Louis Fakename

Name of Account Manager associated with the Plan Sponsor

No

9

Authorized Representative Name

Joseph Fakename

Name of Authorized Representative associated with the Plan Sponsor

No

10

Authorized Representative Verification Status

Approved

Indicates whether the Plan Sponsor has approved the Authorized Representative to act on the Plan Sponsor's behalf

No

11

Application ID

84361

A unique number assigned to an Application that does not change

No

12

Plan Name

Fake Rx Plan

Name associated with the Application

No

13

Plan Year Start Date

2008-01-01

The beginning date defining the Plan Year

No

14

Plan Year End Date

2008-12-31

The ending date defining the Plan Year

No

15

Application Status

Reconciliation Cost Reporting Opened

Current Status of the Application

No

16

Application Status Date

2009-09-18

The date associated with the latest Application Status

No

17

Interim Payment Frequency

Monthly

Indicates how frequently the Plan Sponsor can request payment on the Application

No

18

Total Paid To Date

52132.82

Total amount that has been paid to date for the Application

No

19

Retiree Submissions Ready

Closed

Open/Closed indicator of whether or not retiree files were accepted by CMS' RDS Center

Yes

20

Retiree List Submission Method

RDS Secure Website to RDS Center

Retiree data submission method to CMS' RDS Center; defined during the Application Process

No

21

Submitter ID

999999

Submitter ID associated to the Vendor, Plan Sponsor, VDSA, or MIR submitting retiree files

No

22

Submitter Name

Gregory Fakename

Submitter name associated to the Vendor, Plan Sponsor, VDSA, or MIR submitting retiree files

No

23

Retiree List Response Method

RDS Secure Website to RDS Center

The method by which retiree data is communicated to the Submitter or Plan Sponsor.

No

24

Weekly Notification File Delivery Method

RDS Secure Website only

Delivery method for notifications from CMS' RDS Center concerning Qualifying Covered Retirees

No

25

Last Covered Retiree List Created Date

2009-06-04

The last date that a Covered Retiree List was generated for the Application

No

26

Payment Setup Complete

Yes

A Yes/No indicator that all steps of Payment Setup are complete

Yes

27

Cost Report Ready

Final Open

Indicates whether Cost Reports are ready to be accepted by CMS' RDS Center

Yes

28

Reconciliation Deadline Date

2010-03-31

Date Reconciliation must be completed by to avoid an overpayment

No

29

Last Completed Recon Step

5

The Reconciliation step last completed by the Plan Sponsor

No

30

Recon Step Date/Time

2010-09-18 13:42:05

Date and time the Plan Sponsor completed the Reconciliation step

No

31

Benefit Option Name

UboiA

Name of a particular benefit design, category of benefits, or cost-sharing arrangement offered within a group health plan

No

32

Unique Benefit Option Identifier

00ASO2002

A unique identifier for each Benefit Option on the Application

No

33

UBOI Eligible Retiree Count

14

Unique number of eligible retirees associated with the Benefit Option

No

34

Multiple Cost Reporters Assigned

No

A Yes/No indicator that multiple sources have been assigned to report costs for the Benefit Option

Yes

35

Costs Accepted From Another Reporting Source

Yes: Interim Costs Greater Than Zero

Indicates if a Benefit Option has costs greater than zero from more than one source

No

36

Cost Reporter Type

A01

Vendor Identifier or the text "Plan Sponsor"

No

37

Last Cost Report Accepted File Receipt Date/Time

2008-08-02 14:18:07

The file receipt date/time associated with the last Cost Report for the Benefit Option accepted by CMS' RDS Center

No

38

Last Cost Report Accepted Processed Date

2008-08-03

The date a Cost Report submitted by the Cost Reporter was last accepted by CMS' RDS Center for the given Benefit Option

No

39

Last Cost Report Accepted Status

Included in Payment Request

This is the most current status associated with the last Cost Report accepted by CMS' RDS Center

No

40

Last Cost Report Accepted Status Date

2008-10-21

The date associated with the Last Cost Report Accepted Status

No

41

Last Cost Report Accepted Type

Interim

The timing of the most recently accepted Cost Report (Interim or Final)

No

42

Last Cost Report Accepted Allowable Retiree Cost

45452.98

The total Allowable Retiree Costs for the Benefit Option included in the last Cost Report accepted by CMS' RDS Center

No

43

Last Cost Report Rejected File Receipt Date/Time

2008-09-18 12:12:07

File receipt date and time associated with the last Cost Report for the Benefit Option rejected by CMS' RDS Center

No

44

Last Cost Report Rejected File Processed Date

2008-09-20

The date a Connect:Direct Cost Report submitted by the Cost Reporter was last rejected by CMS' RDS Center for the Benefit Option

No

45

Last Cost Report Rejected Status

Connect:Direct Errors Detected

Indicates that errors were detected in the Connect:Direct Cost Report

No

46

Last Cost Report Rejected Type

Final

The timing of the most recently rejected Cost Report (Interim or Final)

No

47

Last Cost Report Rejected Allowable Retiree Cost

82321.56

The total Allowable Retiree Costs for the Benefit Option included in the last Cost Report rejected by CMS' RDS Center

No

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