CMS Pub. 100-24, ch. 3, § 3.5.6

All states receive date change records, but reply records are generated only for states

receiving daily response files. RIC-D reply records provide notification of actions that

will affect billing and are, therefore, considered a pre-billing notification.

Item Field Size Position Format Description

1 Medicare Number 12 1-12 Alpha-numeric

The beneficiary HICN, a

nine-position numeric

value followed by an

alpha-numeric BIC. If the

beneficiary is entitled

under a RRB claim

number, this field will

contain an 11-position

alpha-numeric pseudo

HICN. Positions 11 and

12 may be blank. This

field will convey the

Medicare number from

the EDB. CMS will not

return the MBI in this

state buy-in reply.

Item Field Size Position Format Description

2 Surname 24 13-36 Alpha-numeric

A maximum of 24 alpha-numeric characters. The

name will match the

surname on the EDB.

Any unused positions will

be blank.

3 Given Name 15 37-51 Alphabetic A maximum of 15

alphabetic characters.

The name will match the

given name on the EDB.

Any unused positions will

be blank.

4 Middle Initial 1 52 Alphabetic An alphabetic character.

If the beneficiary’s

middle initial is not

reflected on the EDB, the

field will be blank.

5 Sex Code 1 53 Alphabetic A one-position alphabetic

code (male = “M,”

female = “F”).

6 Date of Birth 8 54-61 Numeric An eight-position

numeric field,

CCYYMMDD. A date

such as November 1,

1939 will be displayed as

19391101. The date of

birth will match the date

of birth on the EDB.

7 Beneficiary’s

Social Security

Number

9 62-70 Numeric A nine-position numeric

field. The SSN will be

extracted from the EDB.

This field may be blank if

the EDB does not

currently have the

beneficiary’s SSN.

Item Field Size Position Format Description

8 Filler or Reduced

Part A Indicator

1 71 Numeric or

Alphabetic

When the transaction

code in position 77-78 is

“30,” this field will be

blank. For states

receiving daily files,

when the transaction

reply code is not “30,”

the presence of a “1” in

this position means the

reduced Part A premium

rate applies; otherwise, it

will be blank, unless the

state submitted a buy-in

eligibility code with their

Part A buy-in. If so, the

BIEC submitted for Part

A will be displayed.

9 Filler or Part A

Premium

Surcharge

Indicator

1 72 Numeric or

Blank

When the transaction

code in position 77-78 is

“30,” this field will be

blank. For states

receiving daily files,

when the transaction

reply code is not “30,”

the presence of a “1” in

this position means the

Part A premium includes

a 10% surcharge for late

enrollment; otherwise, it

is blank.

10 Agency Code 3 73-75 Alpha-numeric

A three-position alpha-numeric code, beginning

with “S,” assigned to the

state which has

jurisdiction over the

account.

Item Field Size Position Format Description

11 Record

Identification Code

“D”

1 76 Alphabetic “D” constant. The “D”

identifies this record as a

date change record or,

for states receiving daily

response files, when the

transaction reply code is

not “30,” a reply record.

12 Transaction Code 4 77-80 Numeric A two- or four-position

numeric code. When

CMS must adjust the

effective date of an

incoming accretion

transaction to a later

date to conform to the

Medicare entitlement

date, the first two

positions contain the

value of “30.” The last

two positions will contain

the same transaction

code as was present on

the state input record.

For states receiving daily

response files, when the

transaction reply code is

not “30,” the first two

positions convey CMS'

reply to a state's

accretion or deletion

request. The last two

positions will contain the

same transaction code as

was present on the state

input record. For these

daily exchange states, the

two- or four-position

transaction code may

also convey that CMS

processed a debit or

credit billing action,

received from another

source, on behalf of the

state.

Item Field Size Position Format Description

13 Transaction SubCode

1 81 Alphabetic A one-position alphabetic

code that further defines

the transaction code.

14 Transaction Date

from state record

or the Billing

Period Start Date

(CCYYMM)

6 82-87 Numeric A six-position numeric

date field. When the

transaction reply code is

“30,” this field contains

the accretion transaction

effective date submitted

by the state, the date

which CMS adjusted to a

later date. The resulting

adjusted date is reflected

on an accompanying

billing record. For those

states receiving daily

files, when the

transaction reply code is

not “30,” this field

contains the beginning

date (year and month)

used in calculating a

refund or debit premium

amount for this

transaction reply. For

debits, the billing period

start date also represents

the applied transaction

effective date. For

credits, the transaction

effective date is

equivalent to the billing

period start date minus

one month. NOTE: the

billing period start and

stop dates are inclusive

dates.

Item Field Size Position Format Description

15 Filler or Billing

Period Stop Date

(CCYYMM)

6 88-93 Numeric When the transaction

reply code is “30,” this

field will be blank. For

those states receiving

daily files, when the

transaction reply code is

not “30,” this field will

be a six-position numeric

field that contains the

last date (year and

month) used in

calculating the refund or

premium amount for this

transaction. NOTE: the

billing period start date

and the billing period

stop date are inclusive

dates.

16 Filler or Code

1728 Accretion

State Agency Code

3 94-96 Alpha-numeric

When the transaction

reply code is “30,” this

field will be blank. For

those states receiving

daily files, when the

transaction reply code is

not “30,” this field will

be a three-position

alpha-numeric state

agency code, beginning

with “S,” provided in all

code 1728 deletion

replies identifying the

accreting state which

now claims buy-in

jurisdiction for this

beneficiary. Otherwise,

this field will remain

blank.

17 Filler 22 97-118 Positions reserved for

future use.

Item Field Size Position Format Description

18 Reply Date

(CCYYMMDD)

8 119-126 Numeric An eight-position

numeric field. This is the

date on which CMS

created the RIC-D

record.

19 ZIP Code of

Residence

9 127-135 Numeric A nine-position numeric

code that is reflected on

the EDB. If the EDB only

reflects the five-position

zip code, the five

positions will be reflected

and the remaining

positions will be blank.

20 County Code of

Residence

3 136-138 Numeric A three-position numeric

code developed from the

EDB. The field may be

blank.

21 Filler 2 139-140 Positions reserved for

future use.

22 Agency Client

Identification

Number

20 141-160 Alpha-numeric

The beneficiary’s client

(or Medicaid)

identification number or

any other identifier of the

state’s choice.