Connect: Direct Applications for RAPS, Encounter, PDE, and MMP

Palmetto GBA

OMB No. 0938-1152

(Expires: TBD)

Connect:Direct Parameters for the
Submission of Prescription Drug Event (PDE) Data

Contract ☐ Submitter ☐

The Connect:Direct node connection information that you will require for the connection to Palmetto GBA is as follows:

Palmetto SNA Values		Palmetto TCP/IP Values
Net ID:	SCA	NAT’d IP Address:	32.90.254.160
Node ID:	SCA.A70NDM.MC	Listener Port:	1369
Appl ID:	A70NDMMC PGBA	Node ID: AGNS	SCA.A70NDM.MC
AGNS ID:		ID:	PGBA

Please list below the information Palmetto GBA requires to deliver files to your system via Connect:Direct (Required ):

This is required for Contracts and Submitters that want reports returned directly to them.	Please indicate whether you wish to connect to Palmetto GBA through SNA or TCP/IP.

Contract ☐ Submitter ☐

Palmetto SNA Values		Palmetto TCP/IP Values
Net ID:		NAT’d IP Address:
Node ID:		Listener Port:
Appl ID:		Node ID: AGNS
AGNS ID:		ID:

Please list below the User ID and Password Palmetto GBA will require in order to connect to your system via Connect:Direct (if your datasets are RACF protected). This is required for Contracts and Submitters that want reports returned directly to them.

User ID:		Password:

This section pertains to Submitters only.

PRESCRIPTION DRUG Transaction Submission (PDE Dataset):

Listed below are the file parameter values that you, the submitter, will require in order to code your Connect:Direct SCL:

DSN:	MAB.PROD.NDM.PDFS.PROD.<submitter id>(+1)
DISP:	(NEW,CATLG,DELETE)
UNIT:	SYSDG
SPACE:	(CYL,(1200,500),RLSE)
DCB:	(RECFM=FB,LRECL=512,BLKSIZE=27648)

Note: For testing, use MAB.PROD.NDM.PDFS.TEST.<submitter id>(+1)

Please note that the test/prod indicator in the file HDR record, field 5, must also indicate “TEST” or “PROD”, depending on the type of file being submitted.

PDFS Reports

Response Report Retrieval (Enter Dataset Names below)

Please enter the Dataset Names (DSNs) that resides on your system, where you want Palmetto GBA to place your reports. This dataset should be GDG. This will allow multiple files to be sent to you without your manual intervention or accidental overwriting of existing files.

(PDFS) Response Report

Frequency:	Daily
Report DSN:

DCB=(DSORG=PS,LRECL=80,RECFM=FB,BLKSIZE=27920)

This page is required for Submitters. Contracts must fill in the appropriate information that want reports returned directly to them.

DDPS (Daily) Reports

Report Retrieval (Enter DSN below)

Please enter the name of the datasets that reside on your system, where you want Palmetto GBA to place your reports. These datasets should be GDG. This will allow multiple files to be sent to you without your manual intervention or accidental overwriting of existing files.

DDPS Return File – Report #1
Frequency:	Daily
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS Transaction Error Summary – Report #3
Frequency:	Daily
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

This page is required for Submitters. Contracts must fill in the appropriate information that want reports returned directly to them.

Only Contracts and Designated Submitters can receive Monthly Reports.

If a contract wishes to have Monthly reports returned to them, please provide a return DSN for that Monthly report in the space provided below. Submitters can fill in information in the spaces provided only if a contract has elected them as a Designated Submitter.

CMS returns Monthly reports separated by the Date of Service. Monthly reports will be sent for the Current Year in process and the Previous Year until the deadline is reached for the Previous Year Date of Service.

DDPS (Monthly) Reports (Current Year Date-Of-Service)

Report Retrieval (Enter DSNs below)

Please enter the name of the datasets that reside on your system, where you want Palmetto GBA to place your reports. These datasets should be GDG. This will allow multiple files to be sent to you without your manual intervention or accidental overwriting of existing files.

DDPS 04COV Cumulative Beneficiary Activity For Covered Drugs
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS 04ENH Cumulative Beneficiary Activity For Enhanced Alternative Drugs
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS 04OTC Cumulative Beneficiary Activity For Over-the-Counter Drugs
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

This page is required for Contracts or Submitters that have been set up as Designated Submitters.

Only Contracts and Designated Submitters can receive Plan-to-Plan reports.

If a contract wishes to have Plan-to-Plan reports returned to them, please provide a return DSN for these reports in the space provided below. Submitters can fill in information in the spaces provided only if a contract has elected them as a Designated Submitter.

DDPS Plan-to-Plan Reports (Current Year Date-Of-Service)

Report Retrieval (Enter DSNs below)

Please enter the name of the datasets that reside on your system, where you want Palmetto GBA to place your reports. These datasets should be GDG. This will allow multiple files to be sent to you without your manual intervention or accidental overwriting of existing files.

DDPS 40COV PDE Accounting Report For Covered Drugs
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS 40ENH PDE Accounting Report For Enhanced Drugs
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS 40OTC PDE Accounting Report For Over-the-Counter Drugs
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS Plan-to-Plan Reports (Continued)

DDPS 41 PDE Receivable Report
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS 42 PDE Part-D Payment Reconciliation Report
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS 43 PDE Payable Report
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS (Monthly) Reports (Previous Year Date of Service)

DDPS 04COV Cumulative Beneficiary Activity For Covered Drugs
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS 04ENH Cumulative Beneficiary Activity For Enhanced Alternative Drugs
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS 04OTC Cumulative Beneficiary Activity For Over-the-Counter Drugs
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS Plan-to-Plan Reports (Previous Year Date-Of-Service)

DDPS 40COV PDE Accounting Report For Covered Drugs
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS 40ENH PDE Accounting Report For Enhanced Drugs
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS 40OTC PDE Accounting Report For Over-the-Counter Drugs
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS 41 PDE Receivable Report
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS 42 PDE Part-D Payment Reconciliation Report
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS 43 PDE Payable Report
Frequency:	Monthly
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

This page is required for Submitters.

DDPS Phase III Report – This report will be returned on a On-Demand basis.

Report Retrieval (Enter DSNs below)

Please enter the name of the datasets that reside on your system, where you want Palmetto GBA to place your reports. These datasets should be GDG. This will allow multiple files to be sent to you without your manual intervention or accidental overwriting of existing files.

Phase III Report
Frequency:	On Demand
Flat DSN:

DCB=(DSORG=PS,LRECL=512,RECFM=FB,BLKSIZE=27648)

DDPS Potential Exclusion Warning Report
Frequency:	Quarterly
Flat DSN:

DCB=(DSORG=PS,LRECL=500,RECFM=FB,BLKSIZE=27500)

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1152. The time required to complete this information collection is estimated to average 7 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Baltimore, Maryland 21244-1850. CMS-10340( / )

Enrollment Package/2016 8