Data Changes and Application Corrections FAQs

Rolling Reviews Process

Q1: Is CMS still sharing some review results on a more frequent basis for PY2023?
  • Yes; for PY2023, review areas that are considered “rolling” reviews are shared on a daily basis, starting approximately one week after the Early Bird submission deadline. After the initial and secondary deadlines, the daily results release will be paused for approximately one week. CMS will notify issuers and states once the rolling review results release process resumes after each deadline. For PY2023, CSR – Plan Variation, Data Integrity, Dental MOOP, Silver/Gold, and Standardized Plan Options are the rolling review areas; the remaining review areas are “round-based,” and are posted to the PM Community on a similar cadence as in prior years.
Q2: What is the difference between rolling and round-based review areas?
  • Results for rolling review areas are shared on a daily basis throughout a given review cycle. Results for round-based review areas are shared once per review round during which a review is conducted. For a list of reviews conducted each round, visit the QHP Application Corrections webpage
Q3: Do issuers access rolling and round-based review results in the same location?
  • Yes, both types of results are shared in the Corrections tab of the PM Community, and can be downloaded as an Excel or PDF file from this tab. The Corrections tab consolidates all active corrections that issuers need to make to their applications, and contains only results from CMS’s most recent review. Issuers and states can also access the complete list of review results for a given plan year by visiting the relevant issuer’s page in the Issuers tab or Issuers in State tab of the PM Community. 
Q4: How do issuers know when new review results are posted in the PM Community?
  • CMS will notify issuers and states when new round-based review results are posted in the PM Community. While CMS will send periodic reminders throughout the QHP certification cycle, issuers and states are encouraged to check the Corrections tab of the PM Community 1-2 business days after submitting QHP Application data to check for updated rolling review results. As a reminder, the rolling reviews process will begin approximately one week after the Early Bird deadline. 
Q5: When reviewing corrections in the PM Community, how can an issuer determine whether CMS is reviewing the most recent data that was submitted?
  • For each correction record in the Corrections tab of the PM Community, there is a field that indicates the Review Round. Review results displaying are based on QHP Application data that CMS received as of the date included in the Review Round field. For round-based review results, this field includes the review round and applicable deadline. For rolling review results, CMS conducted its review on the issuer's QHP Application data that was on file on the date in this field. CMS is reviewing and releasing results for rolling review areas more frequently than round-based review areas. Because of this approach, rolling and round-based review results may be based on QHP Application data that was submitted/transferred to CMS on different dates. Issuers and states should closely check the Review Round field’s date when reviewing corrections in the PM Community.
Q6: If an issuer submits corrected QHP Application data based on rolling review results, when will the PM Community reflect the updated review results?
  • For rolling review results, issuers that submit QHP Application data via HIOS should check the PM Community 1-2 business days after submitting their updated data. For issuers that submit QHP Application data via SERFF, rolling review results are updated 1-2 business days after states transfer application data from SERFF to HIOS.
Q7: If an issuer submits corrected QHP Application data based on both rolling and round-based review results, will the PM Community reflect updated review results for both types of review areas at the same time?
  • Most likely, no; round-based review results are only updated in the PM Community once per review round (Early Bird, initial, secondary, and final), while rolling review results are updated daily. CMS encourages issuers to submit corrected data as soon as possible in order to review updated rolling review results and to avoid potential late submission issues, but updated round-based review results based on resubmitted data will not be available until the next review round’s results are released. 

QHP Application Corrections

Q1: Can issuers add new plans after the initial submission deadline?

  • No. After the initial submission deadline, issuers cannot add new plans to a Qualified Health Plan (QHP) Application or change an off-Exchange plan to both on- and off-Exchange.

Q2: If an issuer is making a change to its application in response to a correction identified by CMS, is the issuer required to submit a data change request?

  • No. An issuer is not required to submit a data change request to CMS if it is revising the application in response to a correction issued by CMS. 
Q3: How should an issuer respond to corrections identified during the QHP Application submission window?
  • To address QHP Application review results, issuers should respond by either correcting their QHP Applications or providing adequate justification to demonstrate that corrections are not required. Errors and corrections must be addressed before the affected plans can be certified and/or displayed on HealthCare.gov. 

    Application templates should be submitted through the appropriate submission system. All issuers are required to submit their Plan ID Crosswalk Template and supporting documentation in the PM Community. For all other templates, issuers in FFE states should submit their revised templates and other supporting documents through Health Insurance Oversight System (HIOS). Issuers in states performing plan management functions as well as state based exchanges and submitting through the System for Electronic Rates & Forms Filing (SERFF) should coordinate with regulators to ensure submission and transfer of the updated data to CMS.

    Issuers may upload revised data templates and other supporting documents (and states may transfer them) on an as-needed basis up until the final data submission deadline.

Data Change Requests

Q1: Are issuers in State-based Exchanges using the Federal Platform (SBE-FPs) required to submit data change requests?

  • No. The data change request process applies only to issuers in Federally-facilitated Exchanges (FFEs), including issuers in States performing plan management functions. Issuers in SBE-FPs should work directly with the appropriate state regulator.
Q2: How can an issuer make changes to their QHP Application data?
  • Data change request instructions can be found on the QHP Website.
Q3: How can an issuer determine if its data change request has been received/approved?
  • After submitting a data change request, issuers can view the status of their request in the PM Community.

Other

Q1: How do issuers make changes to incorrect customer service numbers listed on HealthCare.gov for their organization?

  • Administrative information displayed on the HealthCare.gov website will be pulled from Issuer Marketplace Information Fields in the Health Insurance Oversight System (HIOS). If either the Marketplace Billing Name or Marketplace Issuer Marketing Name is missing, the Issuer Legal name from the Issuer General Information section in HIOS will display in its place. This applies to all issuers, including those who file through the System for Electronic Rate and Form Filing (SERFF).

    Changes to administrative data, including customer service numbers, should be made in the View Issuer Submitted Data Tab of the HIOS Plan Finder Product Data Collection module. Issuers can make such changes at any time. If an issuer needs to change their Marketplace marketing name or customer service information (phone number or URL), please note the following:

    You must have a submitter role in HIOS to make changes. Instructions on how to update fields in the HIOS Plan Finder Module are contained in Section 3.2 of the HIOS Plan Finder—Issuer User Manual.