{"text_format":"1","workbook":"xlsx","n_sheets":3,"sheets":["EnableMacros","Issuer Level Data","Plan Level Data"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":1,"defined_names":4,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"EnableMacros","index":0,"n_rows":17,"n_cols":2,"rows_kept":17,"cut":false,"hidden":false,"merged":[[0,0,0,15],[1,0,1,15],[2,0,2,15]]}
["Transparency in Coverage Template"]
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[null,"If you are seeing this sheet, macros are not enabled, please follow the following steps: "]
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[null,"If using Excel 2007 and 2010:"]
[null,"1. Set the macro security setting to Disable macros with notifications (Recommended) or Enable all macros. To change"]
[null,"    the macro security setting, click the Office Button and select Excel Option -> Trust Center -> Trust Center Settings -> "]
[null,"    Macro Settings."]
[null,"2. If the macro security setting is set to Disable macros with notifications, click the Option button and select Enable this "]
[null,"    content."]
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[null,"Note: This screen will flash momentarily when you save or finalize this workbook."]

{"sheet":"Issuer Level Data","index":1,"n_rows":21,"n_cols":11,"rows_kept":21,"cut":false,"hidden":true,"merged":[[2,10,2,11],[2,0,2,1],[3,0,3,1],[2,2,2,3],[2,4,2,5],[2,6,2,7],[2,8,2,9]]}
["Press TAB and directional arrow keys to read through the document. Template instructions in cell A2. Table values begin in cell B10.","OMB control number: 0938-1310/Expiration date: 04/22/2022"]
["All fields with an asterisk (*) are required. To validate the template, press Validate button or Ctrl + Shift + I. To finalize the template, press Finalize button or Ctrl + Shift + F."]
["Centers for Medicare & Medicaid Services (CMS) Qualified Health Plan (QHP) Transparency in Coverage Reporting",null,"Centers for Medicare & Medicaid Services (CMS) Qualified Health Plan (QHP) Transparency in Coverage Reporting",null,"Centers for Medicare & Medicaid Services (CMS) Qualified Health Plan (QHP) Transparency in Coverage Reporting",null,"Centers for Medicare & Medicaid Services (CMS) Qualified Health Plan (QHP) Transparency in Coverage Reporting",null,"Centers for Medicare & Medicaid Services (CMS) Qualified Health Plan (QHP) Transparency in Coverage Reporting",null,"Centers for Medicare & Medicaid Services (CMS) Qualified Health Plan (QHP) Transparency in Coverage Reporting"]
["Plan Year 2021 v1.0"]
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["General Information"]
["Was this Issuer on the Exchange in 2019?*"]
["Issuer HIOS ID*"]
["Issuer Level Data"]
["Number of Issuer Level Claims with Date(s) of Service (DOS) in 2019 That Were Also Received in Calendar Year 2019*"]
["Number of Issuer Level Claims with DOS in 2019 That Were Also Denied in Calendar Year 2019*"]
["Number of Issuer Level Internal Appeals Filed in Calendar Year 2019*"]
["Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals*"]
["Number of Issuer Level External Appeals Filed in Calendar Year 2019*"]
["Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals*"]
["Notes:"]
["Please enter any comments/notes here."]
["PRA Disclosure Statement: PRA  Disclosure Statement:     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 0938-1310.  The time required to complete this information collection is estimated to average 2520 minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.  If you have 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, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. ****CMS Disclosure****  Please do not send applications, claims, payments, medical records or any documents containing sensitive information to the PRA Reports Clearance Office.  Please note that any correspondence not pertaining to the information collection burden approved under the associated OMB control number listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your documents, please contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325)."]

{"sheet":"Plan Level Data","index":2,"n_rows":6,"n_cols":10,"rows_kept":6,"cut":false,"hidden":true,"merged":[[3,0,3,9],[4,0,4,9],[2,0,2,11]]}
["Press TAB and directional arrow keys to read through the document. Template instructions in cell B1. Table values begin in cell A7.","All fields with an asterisk (*) are required. To validate the template, press Validate button or Ctrl + Shift + I. To finalize the template, press Finalize button or Ctrl + Shift + F."]
[null,"All plan IDs submitted via Plans & Benefits Template(s) must be included in this template."]
["Centers for Medicare & Medicaid Services (CMS) Qualified Health Plan (QHP) Transparency in Coverage Reporting"]
["Plan Year 2021"]
["Plan Level Data"]
["Plan ID*","Number of Plan Level Claims with DOS in 2019 That Were Also Received in Calendar Year 2019*","Number of Plan Level Claims with DOS in 2019 That Were Also Denied in Calendar Year 2019*","Number of Plan Level Claims with DOS in 2019 That Were Also Denied Due to Prior Authorization or Referral Required in Calendar Year 2019*","Number of Plan Level Claims with DOS in 2019 That Were Also Denied Due to an Out-Of-Network Provider/Claims in Calendar Year 2019*","Number of Plan Level Claims with DOS in 2019 That Were Also Denied Due to Exclusion of a Service in Calendar Year 2019*","Number of Plan Level Claims with DOS in 2019 That Were Also Denied Due to Lack of Medical Necessity, excluding Behavioral Health in Calendar Year 2019*","Number of Plan Level Claims with DOS in 2019 That Were Also Denied Due to Lack of Medical Necessity, Behavioral Health only, in Calendar Year 2019*","Number of Plan Level Claims with DOS in 2019 That Were Also Denied for \"Other\" Reasons in Calendar Year 2019*","Notes: (Please enter any comments/notes here.)"]