Machine-Readable Data

Issuers seeking certification to offer QHPs on the Federally-facilitated Exchange (FFE) are required to submit provider and formulary data in a machine-readable format to CMS and for posting on issuer websites. CMS’s machine-readable data initiative provides a structured and predictable dataset that supports the function of HealthCare.gov’s Decision Support Tools, and is used by third-party application developers and researchers. HealthCare.gov and its Direct Enrollment partner websites use machine-readable data to allow consumers to filter available QHPs based on the providers and drugs covered by those QHPs.

QHP issuers on the FFE are required to create a set of machine-readable data files using the JavaScript Object Notation (JSON) format specified by CMS. There are four types of machine-readable data files: 

  • Index files, which are used to organize and find the other file types.
  • Plans files, which contain information on the QHPs offered by the issuer.
  • Provider files, which contain information identifying each participating provider in the issuer’s network.
  • Drugs or formulary files, which contain information about the drugs covered by the QHPs offered by the issuer.

Issuers can review the content requirements for each of these files on the CMS Coverage Portal website.

Within the CMS Coverage Portal, issuers can also access several tools and information for troubleshooting the coverage data submission process for Marketplace application programming interface (API). Issuers can validate coverage JSON, learn about how to debug common errors, and look up information about providers.

Issuers should reference the QHP Data Submission and Certification Timeline for more information on the deadlines for submitting machine-readable data to CMS.

Application Resources