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pdf2019 (old version)
2020 (new version)
Type of Change
Reason for Change
Burden Change
Header:
MEDICAID DRUG REBATE
RECONCILIATION OF STATE INVOICE (ROSI) CMS‐304
ELECTRONIC FORMAT
Header:
MEDICAID DRUG REBATE PROGRAM
RECONCILIATION OF STATE INVOICE (ROSI)
Form CMS‐304
ELECTRONIC FILE FORMAT
Effective: July 1, 2021
Rev
To align Header with other Medicaid Drug
Rebate Program documentation.
N/A
N/A
New File Format Column:
Ordinal Position
Corresponding Rows 1‐10 for Record 1
Corresponding Rows 1‐17 for Record 2
Corresponding Rows 1‐12 for Record 3
Column Name Update:
Field Name (.TXT)
Header Row (.CSV
Add
To update File Format to include .CSV Ordinal
Numbering Column
N/A
Rev
To include .CSV Header Row in additon to the N/A
.TXT Field Name
N/A
New File Format Column:
Position
Positions 1‐141 for Record 1
Positions 1‐193 for Record 2
Positions 1‐169 for Record 3
Add
To align verbiage with other Medicaid Drug
Rebate Program documentation.
N/A
Record ID ‐ Record 1
Size: 1
Remarks: Constant of “1”
Record ID ‐ Record 1
Size: 2
Remarks: Constant of “R1” for ROSI 1
Rev
To align verbiage with other Medicaid Drug
Rebate Program documentation.
N/A
Phone‐ Record 1
Remarks: Area Code/Phone No./Ext. of Contact
Phone‐ Record 1
Remarks: Area Code/Phone No./Ext. of Invoice Contact
Rev
To align verbiage with other Medicaid Drug
Rebate Program documentation.
N/A
Fax ‐ Record 1
Size: 10
Remarks: Labeler’s Contact Fax Number
Email ‐ Record 1
Size: 50
Remarks: Labeler’s Invoice Contact Email Address
Rev
The Fax Field is no longer relevant so it is
being replaced with an Email Field
N/A
Record ID ‐ Record 2
Size: 1
Remarks: Constant of “2”
Record ID ‐ Record 2
Size: 2
Remarks: Constant of “R2” for ROSI 2
Rev
To align verbiage with other Medicaid Drug
Rebate Program documentation.
N/A
Unit Rebate Amount ‐ Record 2
Size: 11
Remarks: 99999V999999
Unit Rebate Amount ‐ Record 2
Size: 15
Remarks: 99999999.999999
Rev
Updated field size from 11 to 15 digits
N/A
Column Name Update:
Field
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
Adjusted Unit Rebate Amount ‐ Record 2
Size: 11
Remarks: 99999V999999
Adjusted Unit Rebate Amount ‐ Record 2
Size: 15
Remarks: 99999999.999999
Rev
Updated field size from 11 to 15 digits
N/A
Units Invoiced ‐ Record 2
Size: 12
Remarks: 999999999V999
Units Invoiced ‐ Record 2
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Adjusted Units (+/‐) ‐ Record 2
Size: 13
Remarks: 9999999999V999
Adjusted Units (+/‐) ‐ Record 2
Size: 17
Remarks: 9999999999999.999
Rev
Updated field size from 13 to 17 digits
N/A
Labeler Disputed Units ‐ Record 2
Size: 12
Remarks: 999999999V999
Labeler Disputed Units ‐ Record 2
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Units Paid ‐ Record 2
Size: 12
Remarks: 999999999V999
Units Paid ‐ Record 2
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Rebate Amount Invoiced ‐ Record 2
Size: 9
Remarks: 9999999V99
Rebate Amount Invoiced ‐ Record 2
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 9 to 16 digits
N/A
Invoice Correction Amount (+/‐) ‐ Record 2
Size: 10
Remarks: 99999999V99
Invoice Correction Amount (+/‐) ‐ Record 2
Size: 17
Remarks: 99999999999999.99
Rev
Updated field size from 10 to 17 digits
N/A
Withheld Invoice Amount ‐ Record 2
Size: 9
Remarks: 9999999V99
Withheld Invoice Amount ‐ Record 2
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 9 to 16 digits
N/A
Rebate Amount Paid ‐ Record 2
Size: 9
Remarks: 9999999V99
Rebate Amount Paid ‐ Record 2
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 9 to 16 digits
N/A
Record ID ‐ Record 3
Size: 1
Remarks: Constant of “3”
Record ID ‐ Record 3
Size: 2
Remarks: Constant of “R3” for ROSI 3
Rev
To align verbiage with other Medicaid Drug
Rebate Program documentation.
N/A
Total Units Invoiced ‐ Record 3
Size: 12
Remarks: 999999999V999
Total Units Invoiced ‐ Record 3
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Total Adjusted Units (+/‐) ‐ Record 3
Size: 13
Remarks: 9999999999V999
Total Adjusted Units (+/‐) ‐ Record 3
Size: 17
Remarks: 9999999999999.999
Rev
Updated field size from 13 to 17 digits
N/A
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
Total Labeler Disputed Units ‐ Record 3
Size: 12
Remarks: 999999999V999
Total Labeler Disputed Units ‐ Record 3
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Total Units Paid ‐ Record 3
Size: 12
Remarks:
Total Units Paid ‐ Record 3
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Total Rebate Amount Invoiced ‐ Record 3
Size: 10
Remarks: 99999999V99
Total Rebate Amount Invoiced ‐ Record 3
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 10 to 16 digits
N/A
Total Invoice Correction Amt. (+/‐) ‐ Record 3
Size: 11
Remarks: 999999999V99
Total Invoice Correction Amt. (+/‐) ‐ Record 3
Size: 17
Remarks: 99999999999999.99
Rev
Updated field size from 11 to 17 digits
N/A
Total Withheld Invoice Amount ‐ Record 3
Size: 10
Remarks: 99999999V99
Total Withheld Invoice Amount ‐ Record 3
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 10 to 16 digits
N/A
Total Rebate Amount Paid ‐ Record 3
Size: 10
Remarks: 99999999V99
Total Rebate Amount Paid ‐ Record 3
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 10 to 16 digits
N/A
Plus Interest Payment ‐ Record 3
Size: 8
Remarks: 999999V99
Plus Interest Payment ‐ Record 3
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 8 to 16 digits
N/A
Total Remittance ‐ Record 3
Size: 10
Remarks: 99999999V99
Total Remittance ‐ Record 3
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 10 to 16 digits
N/A
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
| File Type | application/pdf |
| File Title | CMS Form-304 Reconciliation of State Invoice (ROSI)_Electronic Format_Crosswalk_07.2021.xlsx |
| Author | LOKG |
| File Modified | 2020-11-03 |
| File Created | 2020-11-03 |