Application Submission
QHP Application Sections and Groupings
Application
Grouping | Application
Section |
Issuer Attestations and Administrative
Information | Administrative |
Interoperability | |
Program Attestations | |
Plan Business Rules | Business Rules |
Plan Attributes | ECP/NA & Network ID |
Plans & Benefits | |
Prescription Drugs | |
Service Area | |
Issuer Accreditation | Accreditation |
Transparency Data | Transparency in Coverage |
Plan Rates | Rates Table |
URR* | |
Issuer URLs | URL |
* Issuers do not submit the URR Template within the MPMS Module; this application section acknowledges submission of the URR Template through either SERFF or the URR Module within HIOS, depending on the issuer.
Individual application groupings will be locked (i.e., not able to be edited) while CMS conducts reviews for any review areas with results being shared in the MPMS Module. After CMS’s review of all sections within a given group is complete, the application grouping will display a status of Corrections Required or No Action Required, depending on whether required corrections were identified as part of CMS’s reviews. Issuers will receive review results as CMS completes reviews for each application section, but issuers will not be able to make edits to any sections within a group until CMS completes reviews for all sections within that group
- Steps to take prior to the initial submission deadline to help your organization prepare for the certification process;
- Steps for validating data prior to submission, including how to address both validation errors and warnings;
- Specific submission checklists for issuers to reference before each deadline (Early Bird, initial, secondary, and final) with differing SERFF and HIOS requirements delineated;
- Detailed instructions on submitting application data within the correct submission system;
- Actions to take when required corrections are released;
- Guidance on where review results are released for each review area;
- Guidance for completing certain certification activities, such as plan confirmation and agreement-signing; and
- Additional tips specific to SERFF-submitting issuers for each step of the process.
The QHP Certification State Toolkit (Updated 9/5/2023) is a series of consolidated resources that state regulators can use throughout QHP certification to assist with plan management functions on the Health Insurance Exchanges.
- States’ roles and responsibilities throughout the QHP certification process;
- Information on systems both states and issuers use to complete QHP certification;
- Important dates and reminders;
- QHP certification resources; and
- A high-level summary of key updates from CMS guidance.
This
document is a supplemental resource and is not intended to replace official
guidance or instructions.
State regulators should send all questions regarding the QHP Certification
State Toolkit to PlanManagementStateCoordination@cms.hhs.gov.