The following retiree file layouts are available for reference:
Retiree File RDS Secure Website CSV File Layout
If subsidy is being requested for the spouse or dependent of a Qualifying Covered Retiree, make sure the information provided in this record is that of the spouse or dependent, not the retiree.
If a beneficiary's SSN has a leading zero and the field is numeric, leading zeroes are truncated. Reformat the SSN field to "text" before creating the CSV file.
Do not name Retiree Files with the following prefixes, regardless of case: “resp_”, “notify_”, or “covered_”. For example, “Resp_Plan2022.csv” would not be accepted, however “Fullyear_Plan2022.csv” would be accepted.
Note: An asterisk (*) indicates a required field.
| Data Element | Max Size | Notes |
|---|---|---|
| *Application ID | 10 | RDS Application ID under which you are submitting this beneficiary for subsidy. This Application ID must match the Application ID EXACTLY as it appears on the RDS Secure Website, and must correspond to the coverage periods you are submitting. |
| *SSN | 09 |
Social Security Number (SSN) of the beneficiary for whom you are seeking subsidy. This field may be left blank if a Medicare beneficiary identifier is provided.
|
| *Medicare beneficiary identifier | 12 |
This field may be left blank if the SSN is provided. May contain: Medicare Beneficiary Identifier (MBI) of the beneficiary for whom you are seeking subsidy.
Medicare Health Insurance Claim Number (HICN) of the beneficiary for whom you are seeking subsidy.
Railroad Retirement Board (RRB) number of the beneficiary for whom you are seeking subsidy.
|
| *First Name | 30 | First Name of the beneficiary for whom you are seeking subsidy. |
| Middle Initial | 01 | Optional field. Middle Initial of the beneficiary for whom you are seeking subsidy. |
| *Last Name | 40 | Last Name of the beneficiary for whom you are seeking subsidy. |
| *Date of Birth | 08 | Date of Birth of the beneficiary for whom you are seeking subsidy. Format: CCYYMMDD |
| *Sex | 01 | Sex of the beneficiary for whom you are seeking subsidy. Value '0' = Sex Unknown Value '1' = Male Value '2' = Female |
| *Coverage Effective Date | 08 | The date the beneficiary's (retiree, spouse, or dependent) coverage under the Plan Sponsor's Prescription Drug Benefit Option begins. Format: CCYYMMDD |
| *Coverage Termination Date | 08 |
The date the beneficiary's (retiree, spouse, or dependent) coverage under the Plan Sponsor's Prescription Drug Benefit Option ends. Format: CCYYMMDD This field accepts 99999999 or may be left blank if the date is unknown. |
| *Unique Benefit Option Identifier | 20 | Unique Benefit Option Identifier (UBOI) (for example, Rx Group number) corresponding to the benefit under which you are submitting this beneficiary for subsidy. You MUST reference the UBOI in this field exactly as it was entered on the RDS application, including any leading or trailing zeroes, spaces, punctuation, etc. Reference the Benefit Option page in the RDS Secure Website if you are unsure what should be entered in this field. |
| *Relationship to Retiree | 02 | Relationship to the retiree of the beneficiary for whom you are seeking subsidy. Value '01' = Self Value '02' = Spouse Value '03' = Other |
| *Transaction Type | 03 | Value 'ADD' = The beneficiary has either never been submitted for the corresponding RDS Application ID or was submitted but never accepted for a Subsidy Period. Value 'UPD' = The beneficiary and the corresponding UBOI have been previously accepted for a Subsidy Period for the corresponding RDS application and updated information is being sent. Value 'DEL' = The beneficiary has been previously approved for subsidy for the corresponding RDS application and Benefit Option. All coverage under this Benefit Option for this Qualifying Covered Retiree (QCR) should be removed. |
Best Practices for CSV File Layout
- Download the Sample Retiree File Spreadsheet, or create your own spreadsheet or comma separated value (CSV) file.
- Populate the retiree information for each beneficiary.
- Confirm that the file is saved in CSV format.
- If subsidy is being requested for the spouse or dependent of a Qualifying Covered Retiree (QCR), make sure the information provided in this record is that of the spouse or dependent, not the retiree.
- CMS' RDS Center will process multiple records for the same beneficiary within the same retiree file. DEL records will be processed first, followed by ADD and UPD. CMS' RDS Center will disregard the order that these records appear in the file, and will process in the aforementioned order.
For instructions to upload a file to CMS' RDS Center, refer to Submit a Valid Initial Retiree List and Monthly Retiree List.
Retiree File Connect:Direct Record Layout
Header Record
| Data Element | Field Description | Notes |
|---|---|---|
| Record Type | PIC X(01) | Value 'H' = Header Record |
| Application ID | PIC X(10) | The number assigned to the application by CMS' RDS Center. Includes leading zeroes as needed to completely fill the field. |
| Creation Date | PIC X(08) | Date the file was created. Format: CCYYMMDD |
| Creation Time | PIC X(06) | Time the file was created. Format: HHMMSS |
| Filler | PIC X(175) | Spaces |
Detail Record
Note: If subsidy is being requested for the spouse or dependent of a Qualifying Covered Retiree (QCR), make sure the information provided in this record is that of the spouse or dependent, not the retiree.
Note: An asterisk (*) indicates a required field.
| Data Element | Field Description | Notes |
|---|---|---|
| Record Type | PIC X(01) | Value 'D' = Detail Record |
| *SSN | PIC X(09) |
Social Security Number (SSN) of the beneficiary for whom you are seeking subsidy. This field may contain spaces if a Medicare beneficiary identifier is provided.
|
| *Medicare beneficiary identifier | PIC X(12) |
This field may contain spaces if the SSN is provided. May contain: Medicare Beneficiary Identifier (MBI) of the beneficiary for whom you are seeking subsidy.
Medicare Health Insurance Claim Number (HICN) of the beneficiary for whom you are seeking subsidy.
Railroad Retirement Board (RRB) number of the beneficiary for whom you are seeking subsidy.
|
| *First Name | PIC X(30) | First Name of the beneficiary for whom you are seeking subsidy. |
| Middle Initial | PIC X(01) | Optional field. Middle Initial of the beneficiary for whom you are seeking subsidy. |
| *Last Name | PIC X(40) | Last Name of the beneficiary for whom you are seeking subsidy. |
| *Date of Birth | PIC X(08) | Date of Birth of the beneficiary for whom you are seeking subsidy. Format: CCYYMMDD |
| *Sex | PIC X(01) | Sex of the beneficiary for whom you are seeking subsidy. Value '0' = Sex Unknown Value '1' = Male Value '2' = Female |
| *Coverage Effective Date | PIC X(08) | The date the beneficiary's (retiree, spouse, or dependent) coverage under the Plan Sponsor's Prescription Drug Benefit Option begins. Format: CCYYMMDD |
| *Coverage Termination Date | PIC X(08) |
The date the beneficiary's (retiree, spouse, or dependent) coverage under the Plan Sponsor's Prescription Drug Benefit Option ends. Format: CCYYMMDD This field accepts 99999999 if the date is unknown. |
| *Unique Benefit Option Identifier | PIC X(20) | Unique Benefit Option Identifier (UBOI) (for example, Rx Group number) corresponding to the benefit under which you are submitting this beneficiary for subsidy. You MUST reference the UBOI in this field exactly as it was entered on the RDS application, including any leading or trailing zeroes, spaces, punctuation, etc. Reference the Benefit Option page in the RDS Secure Website if you are unsure what should be entered in this field. |
| *Relationship to Retiree | PIC X(02) | Relationship to the retiree of the beneficiary for whom you are seeking subsidy. Value '01' = Self Value '02' = Spouse Value '03' = Other |
| *Transaction Type | PIC X(03) | Value 'ADD' = The beneficiary has either never been submitted for the corresponding RDS Application ID, or was submitted but never accepted for a Subsidy Period. Value 'UPD' = The beneficiary and the corresponding UBOI have been previously accepted for a Subsidy Period for the corresponding RDS application and updated information is being sent. Value 'DEL' = The beneficiary has been previously accepted for a Subsidy Period for the corresponding RDS application and all coverage under this application should be removed. |
Trailer Record
| Data Element | Field Description | Notes |
|---|---|---|
| Record Type | PIC X(01) | Value 'T' = Trailer Record |
| Application ID | PIC X(10) | The number assigned to the application by CMS' RDS Center. Includes leading zeroes as needed to completely fill the field. |
| Creation Date | PIC X(08) | Date the file was created. Format: CCYYMMDD |
| Creation Time | PIC X(06) | Time the file was created. Format: HHMMSS |
| Number of Detail Records | PIC X(07) | Right justified and includes leading zeros as needed to completely fill the field. |
| Filler | PIC X(168) | Spaces |
Best Practices for Connect:Direct Record Layout
For more information, refer to Connect:Direct Retiree List Copybook.
While submitting retiree files using Connect:Direct, consider the following required format and information:
- One header record, one or more detail retiree records, and one trailer record.
- Fixed length file/records.
- Fixed field lengths.
- Unless otherwise stated, all fields are defined as alpha numeric (Cobol PIC X) and left justified.
- If subsidy is being requested for the spouse or dependent of a Qualifying Covered Retiree (QCR), make sure the information provided in this record is that of the spouse or dependent, not the retiree.
- CMS' RDS Center will process multiple records for the same beneficiary within the same retiree file. DEL records will be processed first, followed by ADD and UPD. CMS' RDS Center will disregard the order that these records appear in the file, and will process in the aforementioned order.