The following response file layouts and copybook are available for reference:
- CSV File Layout of Retiree Response Files on the RDS Secure Website
- Retiree Response Files Connect:Direct Record Layout
- Connect:Direct Retiree Response File Copybook
CSV File Layout of Retiree Response Files on the RDS Secure Website
Note: Fields with a caret (^) are filled based on the information the Plan Sponsor has sent to CMS' RDS Center.
| Data Element | Max Size | Notes |
|---|---|---|
| ^Application ID | 10 | The RDS Application ID that was submitted in the retiree file correlating to this Retiree Response File. |
| ^SSN | 09 | Social Security Number (SSN) that was submitted for this beneficiary. This field may be blank if a Medicare beneficiary identifier was provided. |
| ^Medicare beneficiary identifier | 12 |
Medicare beneficiary identifier that was submitted for this beneficiary. This field may be blank if the SSN was provided. May contain:
|
| ^First Name | 30 | First Name that was submitted for this beneficiary. |
| ^Middle Initial | 01 | Optional field. Middle Initial that was submitted for this beneficiary. |
| ^Last Name | 40 | Last Name that was submitted for this beneficiary. |
| ^Date of Birth | 08 | Date of Birth that was submitted for this beneficiary. Format: CCYYMMDD |
| ^Sex | 01 | Sex that was submitted for this beneficiary. Value '0' = Sex Unknown Value '1' = Male Value '2' = Female |
| ^Coverage Effective Date | 08 | The date that was submitted for this beneficiary's (retiree, spouse, or dependent) coverage to begin under the Plan Sponsor's prescription drug Benefit Option. Format: CCYYMMDD |
| ^Coverage Termination Date | 08 | The date that was submitted for this beneficiary's (retiree, spouse, or dependent) coverage to end under the Plan Sponsor's prescription drug Benefit Option. Format: CCYYMMDD |
| ^Unique Benefit Option Identifier | 20 | Unique Benefit Option Identifier (UBOI) (for example, Rx Group Number) corresponding to the benefit under which was submitted for this beneficiary for subsidy. |
| ^Relationship to Retiree | 02 | Relationship to retiree that was submitted for this beneficiary. Value '01' = Self Value '02' = Spouse Value '03' = Other |
| ^Transaction Type | 03 | Transaction type that was submitted for this beneficiary. Value 'ADD' = Add Value 'UPD' = Update Value 'DEL' = Delete |
| Determination Indicator | 01 | Value 'Y' = Yes, the retiree qualifies for all or some portion of the Subsidy Period for which you applied. Value 'N' = No, the retiree does not qualify for subsidy for the entire period for which you applied. |
| Reason Code | 02 | The Reason Code provides a reason that this beneficiary was not approved or only partially approved for the subsidy for which you applied. For more information, refer to RDS Reason Codes. |
| Subsidy Period Effective Date | 08 | The effective date that the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved. For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes. Format: CCYYMMDD |
| Subsidy Period Termination Date | 08 | The termination date that the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved. For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes. Format: CCYYMMDD |
Retiree Response Files Connect:Direct Record Layout
The retiree response record contains all the original fields (marked with a caret (^)) sent by the Plan Sponsor in the retiree file, plus the Determination Indicator, Subsidy Dates, and Reason Code. The Plan Sponsor may receive multiple responses (records) for a single beneficiary when there is a gap in RDS Coverage Periods based on Medicare entitlement or multiple records have been submitted for the beneficiary.
For more information, refer to Connect:Direct Retiree Response File Copybook.
Header Record
| Data Element | Field Description | Notes |
|---|---|---|
| Record Type | PIC X(01) | Value 'H' = Header Record |
| Application ID | PIC X(10) | The RDS Application ID that was submitted in the retiree file correlating to this Retiree Response File. Includes leading zeroes as needed to completely fill 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: Fields with a caret (^) are filled based on the information the Plan Sponsor has sent to CMS' RDS Center.
| Data Element | Field Description | Notes |
|---|---|---|
| Record Type | PIC X(01) | Value 'D' = Detail Record |
| ^SSN | PIC X(09) | Social Security Number (SSN) that was submitted for this beneficiary. This field may contain spaces if a Medicare beneficiary identifier was provided. |
| ^Medicare beneficiary identifier | PIC X(12) |
Medicare beneficiary identifier that was submitted for this beneficiary. This field may be blank if the SSN was provided. May contain:
|
| ^First Name | PIC X(30) | First Name that was submitted for this beneficiary. |
| Middle Initial | PIC X(01) | Optional field. Middle Initial that was submitted for this beneficiary. |
| ^Last Name | PIC X(40) | Last Name that was submitted for this beneficiary. |
| ^Date of Birth | PIC X(08) | Date of Birth that was submitted for this beneficiary. Format: CCYYMMDD |
| ^Sex | PIC X(01) | Sex that was submitted for this beneficiary. Value '0' = Sex Unknown Value '1' = Male Value '2' = Female |
| ^Coverage Effective Date | PIC X(08) | The date that was submitted for this beneficiary's (retiree, spouse, or dependent) coverage to begin under the Plan Sponsor's Prescription Drug Benefit Option. Format: CCYYMMDD |
| ^Coverage Termination Date | PIC X(08) | The date that was submitted for this beneficiary's (retiree, spouse, or dependent) coverage to end under the Plan Sponsor's Prescription Drug Benefit Option. Format: CCYYMMDD |
| ^Unique Benefit Option Identifier | PIC X(20) | Unique Benefit Option Identifier (UBOI) (for example, Rx group number) corresponding to the benefit under which was submitted for this beneficiary for subsidy. |
| ^Relationship to Retiree | PIC X(02) | Relationship to retiree that was submitted for this beneficiary. Value '01' = Self Value '02' = Spouse Value '03' = Other |
| ^Transaction Type | PIC X(03) | Transaction type that was submitted for this beneficiary. Value 'ADD' = Add Value 'UPD' = Update Value 'DEL' = Delete |
| Determination Indicator | PIC X(01) | Value 'Y' = Yes, the retiree qualifies for all or some portion of the Subsidy Period for which you applied. Value 'N ' = No, the retiree does not qualify for all or some portion of subsidy for which you applied. |
| Reason Code | PIC X(02) | The Reason Code provides a reason that this beneficiary was not approved or only partially approved for the subsidy for which you applied. For more information, refer to RDS Reason Codes. |
| Subsidy Period Effective Date | PIC X(08) | The effective date that the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved. For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes. Format: CCYYMMDD |
| Subsidy Period Termination Date | PIC X(08) | The termination date that the Subsidy Period for which this Qualifying Covered Retiree (QCR) has been approved. For a description of how these dates are filled in combination with specific scenarios, refer to RDS Reason Codes. Format: CCYYMMDD |
| Filler | PIC X(38) | Spaces |
Trailer Record
| Data Element | Field Description | Notes |
|---|---|---|
| Record Type | PIC X(01) | Value 'T' = Trailer Record |
| Application ID | PIC X(10) | The RDS Application ID that was submitted in the retiree file correlating to this Retiree Response File. Includes leading zeroes as needed to completely fill 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) | Includes leading zeroes as needed to completely fill field. |
| Filler | PIC X(168) | Spaces |
Connect:Direct Retiree Response File Copybook
Header Record
| 01 (*) - RETIREE-LIST-HDR | (blank cell) |
| 05 (*) - RECORD-TYPE | PIC X(01) |
| 88 (*) - HEADER | VALUE 'H' |
| 05 (*) - APPLICATION-ID | PIC X(10) |
| 05 (*) - TRANSMIT-DATE | PIC X(08) |
| 05 (*) - TRANSMIT-TIME | PIC X(06) |
| 05 (*) - RECORD-COUNT | PIC 9(07) |
| 05 FILLER | PIC X(27) |
Detail Record
| 01 (*) - RETIREE-ENTRY | (blank cell) |
| 02 (*) - RETIREE-RECORD | (blank cell) |
| 05 (*) - RECORD-TYPE | PIC X(01) |
| 88 (*) - DETAIL | VALUE 'D' |
| 05 (*) - BENE-SSN | PIC X(09) |
| 05 (*) - BENE-MEDICARE-BENEFICIARY-IDENTIFIER | PIC X(12) |
| 05 (*) - BENE-FIRST-NAME | PIC X(30) |
| 05 (*) - BENE-INITIAL | PIC X(01) |
| 05 (*) - BENE-LAST-NAME | PIC X(40) |
| 05 (*) - BENE-BIRTH-DATE | PIC X(08) |
| 05 (*) - BENE-SEX-CODE | PIC X(01) |
| 88 (*) - SEX-UNKNOWN | VALUE '0' |
| 88 (*) - MALE | VALUE '1' |
| 88 (*) - FEMALE | VALUE '2' |
| 05 (*) - COVG-EFF-DATE | PIC X(08) |
| 05 (*) - COVG-TERM-DATE | PIC X(08) |
| 05 (*) - RX-GROUP-NUMBER | PIC X(20) |
| 05 (*) - BENE-RELATIONSHIP | PIC X(02) |
| 88 (*) - SELF | VALUE '01' |
| 88 (*) - SPOUSE | VALUE '02' |
| 88 (*) - OTHER | VALUE '03' |
| 05 (*) - RECORD-ACTION | PIC X(03) |
| 88 (*) - ADD | VALUE 'ADD' |
| 88 (*) - UPDATE | VALUE 'UPD' |
| 88 (*) - DELETE | VALUE 'DEL' |
| 02 (*) - RETIREE-RESPONSE. | (blank cell) |
| 05 (*) - RDS-SUBSIDY-SW | PIC X(01) |
| 05 (*) - RDS-DENIAL-CODE | PIC X(02) |
| 05 (*) - RDS-EFF-DATE | PIC X(08) |
| 05 (*) - RDS-TERM-DATE | PIC X(08) |
| 05 FILLER | PIC X(143) |
| 05 (*) - DCN | PIC X(15) |
Trailer Record
| 01 (*) - RETIREE-LIST-TRL | (blank cell) |
| 05 (*) - RECORD-TYPE | PIC X(01) |
| 88 (*) - TRAILER | VALUE 'T' |
| 05 (*) - APPLICATION-ID | PIC X(10) |
| 05 (*) - TRANSMIT-DATE | PIC X(08) |
| 05 (*) - TRANSMIT-TIME | PIC X(06) |
| 05 (*) - RECORD-COUNT | PIC 9(07) |