Common use of D Records Clause in Contracts

D Records. If a Reporter is providing coverage for a Medicare beneficiary who is classified as an Inactive Covered Individual, on a quarterly/monthly basis the Reporter shall submit this beneficiary information to CMS as a D record in a Non-MSP Input File in the record layout found in Attachment D. When a match is found, the coverage information will be applied to CMS’s systems and used for prescription drug coordination of benefits. Within forty-five (45)/fifteen (15) days of CMS's receipt of the Non-MSP Covered Individual Input File, CMS shall provide the Reporter with Medicare entitlement data regarding individuals identified through the electronic data match. CMS shall provide these data to the Reporter in a file containing the data elements listed in the record layout prescribed in Attachment E, labeled Non-MSP Response File. In cases when a match does not occur (that is, Part D enrollment is not confirmed), the information contained on the Non- MSP Input File record will be sent back to the Reporter using the same Non-MSP Response File layout, without Medicare entitlement information. Following the initial Non-MSP Input File, the Reporter shall submit regularly scheduled file transfers of ongoing changes in its Non-MSP data, consisting of adds, updates and deletes. If the Reporter has entered into a Coordination of Benefits Agreement (COBA) with CMS, it may opt to submit secondary prescription drug coverage using either the COBA or a VDSA. Using the VDSA Implementation Questionnaire found at Attachment M of this Agreement, the Reporter shall indicate whether it will submit secondary prescription drug coverage as a part of this Agreement or via its

D Records. If a Reporter is providing coverage for a Medicare beneficiary who is classified as an Inactive Covered Individual, on a quarterly/monthly basis the Reporter shall submit this beneficiary information to CMS as a D record in a Non-MSP Input File in the record layout found in Attachment D. When a match is found, the coverage information will be applied to CMS’s ’ systems and used for prescription drug coordination of benefits. Within forty-five (45)/fifteen (15) days of CMS's ’ receipt of the Non-MSP Covered Individual Input File, CMS shall provide the Reporter with Medicare entitlement data regarding individuals identified through the electronic data match. CMS shall provide these data to the Reporter in a file containing the data elements listed in the record layout prescribed in Attachment E, labeled Non-MSP Response File. In cases when a match does not occur (that is, Part D enrollment is not confirmed), the information contained on the Non- MSP Input File record will be sent back to the Reporter using the same Non-MSP Response File layout, without Medicare entitlement information. Following the initial Non-MSP Input File, the Reporter shall submit regularly scheduled file transfers of ongoing changes in its Non-MSP data, consisting of adds, updates updates, and deletes. If the Reporter has entered into a Coordination of Benefits Agreement (COBA) with CMS, it may opt to submit secondary prescription drug coverage using either the COBA or a VDSA. Using the VDSA Implementation Questionnaire found at Attachment M of this Agreement, the Reporter shall indicate whether it will submit secondary prescription drug coverage as a part of this Agreement or via itsits COBA. The Reporter may also opt to require its Pharmaceutical Benefit Manager (PBM) to submit files containing the prescription drug coverage of Inactive Covered Individuals, in a format provided by CMS for PBM use in data sharing. In the Implementation Questionnaire (Attachment M of this Agreement), the Reporter shall indicate whether its PBM will submit prescription drug coverage of its Inactive Covered Individuals on the Reporter’s behalf.