CMS Pub. 100-24, ch. 3, § 3.2

CMS updates the state’s buy-in account based on transactions from the state, SSA, and

CMS.

CMS then creates two billing files for each state agency, one for Part A and one for Part

B buy-in records. States receive the response and billing files via their established EFT

method.

The response and billing files are specified as record identification code (RIC) types:

RIC-A Supplemental Security Income (SSI) Alert

RIC-B Monthly Billing Record

RIC-C Medicare Number Change Record

RIC-D Date Change or Reply Record

RIC-E Personal Characteristics Change Record

RIC-F Reject Record

The RIC response file layouts are provided in section 3.5.

For states receiving only monthly files, these files contain all RIC type records: -A, -B, -

C, -D (date change only), -E, and -F.

For states electing to receive daily response files in addition to the monthly billing files,

their response files contain all RIC-A, -C, -D, -E and -F type records but no RIC-B.

Their monthly billing files contain all RIC-B and only RIC-B records, further segregated

by Part A or Part B.

**For the most up-to-date buy-in eligibility, enrollment, and billing information, CMS

recommends that states accept daily response files. This will help to address errors

sooner and minimize burden on the beneficiary. Effective April 1, 2022, federal

regulations at 42 CFR §§ 406.26 and 407.40 require states to submit and receive files on

a daily basis.

In addition to the electronic billing file, the following paper documents are produced and

mailed to the state (see chapter 5):

● The Summary Accounting Statement (SAS) provides an analysis of the state’s

Medicare premium liability as of the most recent state buy-in update. See chapter 5,

appendix 5.C for additional information.

● The Listed Agency Billing (LAB) summary sheet, an agency totals sheet, is a summary

of selected state buy-in transaction codes contained on the state’s billing file (see

chapter 5, appendix 5.D).

The monthly billing file typically arrives in the state no later than the 1st business day of

the month following the update. If the file is not received by the 2nd business day of the

month, the state must notify CMS CO staff within the Office of Financial Management

(OFM)/Accounting Management Group (AMG)/Division of Premium Billing and

Collections (DPBC) so that CMS may initiate another transmission of the state’s billing

files (see chapter 6, section 6.1.1.1 for contact information).

The SAS and related documents are mailed separately and typically arrive in the state no

later than the 20th of the month. If the documents are not received by the 20th of the

month, the state must notify DPBC staff so that duplicate documents may be mailed.