QHP Application Corrections

Throughout the QHP Application submission process, CMS releases review results to issuers in the Plan Management (PM) Community on a rolling basis. These review results include required corrections that issuers need to make to their applications.

As reviews are completed, CMS will update the PM Community with new corrections and notify issuers that new review results are available. Issuers are encouraged to log into the PM Community to review these corrections. Corrections released in the PM Community include those identified during CMS reviews prior to certification (before and after the final deadline), and after data change windows.

  • For corrections released before the final QHP Application submission deadline: Issuers should make corrections to their applications and submit their updated data to CMS as soon as possible, but by no later than the deadlines specified in the QHP Data Submission and Certification Timeline bulletin. For some review areas, CMS will re-review data resubmitted and release additional review results prior to the final deadline.
  • For corrections released after the final QHP Application submission deadline: Issuers should review the corrections and follow instructions from CMS to make corrections and submit updated data, if needed. These corrections include those released after data change windows, and machine-readable data reviews.

For issuers applying to offer one or more QHPs on-Exchange, these corrections will also include any critical data errors identified by the Data Integrity Tool (DIT). Errors and corrections must be addressed before the affected QHPs can be certified and/or displayed on HealthCare.gov. 

Please be advised that CMS’s review is limited to compliance with QHP/SADP certification standards and does not constitute or imply a determination of the QHP Application’s compliance with requirements under state law. Issuers should consult with the applicable state(s) (and CMS in states that do not enforce market-wide requirements) regarding the requirements and processes for any rate or product reviews. 

Ensure You Receive Communications from CMS Regarding Your QHP Application

To ensure receipt of communications regarding QHP Application corrections, certification notices, and other notifications, issuers should manage their contacts within the Organizations tab of the PM Community. For more information on maintaining contacts for your organization, visit the Register for Updates webpage.

Common Issuer Corrections Guidance

The Common Issuer Corrections Guidance document compiles some of the most common corrections issuers submitting QHP Applications have received in prior plan years. This document includes correction codes, correction language, and tips on resolving each identified correction. Issuers are encouraged to review this document throughout the QHP Application submission process. 

Review Area by Exchange Type & Review Round

The table below indicates which review areas each state Exchange type can expect to see in the PM Community as new corrections are released for each review round. Issuers and states also receive email notifications when new corrections are available. Issuers and states can also refer to the Review Area by Exchange Type Table for more information on each review, including guidance on whether CMS or the state is primarily responsible for reviewing applicable QHP Application data to ensure its compliance with certification standards.

For plan year (PY) 2023, CMS is releasing updated Cost Sharing Reduction (CSR) – Plan Variation, Data Integrity, Standardized Plan Options, Dental MOOP, and Silver/Gold results within 1-2 business days after data submission/transfer starting approximately one week after the Early Bird deadline. All issuers that have submitted a complete and valid QHP Application will start receiving CSR – Plan Variation, Data Integrity, Standardized Plan Options, Dental MOOP, and Silver/Gold review results on a rolling basis at this time, regardless of Early Bird participation.

Review areas are grouped into two categories: rolling and round-based

  • Rolling review areas: Results for these review areas are shared on daily basis, starting after the Early Bird deadline, unless otherwise noted. 
For the Transparency in Coverage and Machine-Readable Index URLs, CMS will release review results daily after the initial submission deadline through Open Enrollment. For the Marketing URL (Plan Brochure, Formulary, SBC, Network) Functionality review areas, CMS will release review results weekly after the final submission deadline and daily after the agreement signing deadline through Open Enrollment. All reviews of URL functionality will shift to a weekly rolling cadence after Open Enrollment concludes. 

Rolling review areas for PY2023 include CSR – Plan Variation, Data Integrity, Standardized Plan Options, Dental MOOP, Silver/Gold, Machine-Readable Index URLs, Transparency in Coverage URLs, and Marketing URL (Plan Brochure, Formulary, SBC, Network) Functionality.

Any time an issuer submits data or a state transfers data, CMS will post updated CSR – Plan Variation, Data Integrity, Standardized Plan Options, Dental MOOP, and Silver/Gold review results based on that data in the PM Community within 1-2 business days. CMS encourages issuers to log into the PM Community on a regular basis throughout the application submission period to check the rolling review results that are released daily and make the necessary updates to their application data as soon as possible. Issuers submitting QHP Applications via SERFF will see updated results in the PM Community 1-2 business days after their state transfers the updated data. CMS will post updated URL functionality review results within 1-2 business days after an issuer submits in HIOS, in accordance with the timeframes detailed in the section above. 
  • Round-based review areas: Results for these review areas are shared once per review round during which a review is conducted; issuers and states receive email notifications when new round-based review results are available. Review areas are considered round-based review areas unless otherwise specified in the table below.

Frequently asked questions (FAQs) regarding this process are posted to the Data Changes and Application Corrections FAQs webpage

Review Area by Exchange Type & Review Round

Review Area

Exchange Type

Review Round

Early Bird

Initial Round

Secondary Round

Final Round

Accreditation

FFE

Administrative

FFE, state performing plan management functions, SBE-FP

Cost Sharing Reduction (CSR) – Plan Variation

FFE, state performing plan management functions

Rolling review results released daily, starting approximately one week after the Early Bird deadline.

Dental Maximum Out of Pocket (MOOP)

FFE

Rolling review results released daily, starting approximately one week after the Early Bird deadline.

Data Integrity

FFE, state performing plan management functions, SBE-FP

Rolling review results released daily, starting approximately one week after the Early Bird deadline.

Essential Community Providers

FFE

Interoperability

FFE, state performing plan management functions

*

Machine-Readable Index URLs

FFE, state performing plan management functions, SBE-FP

Rolling review results released daily, starting after the initial submission deadline.

Non-Discrimination (Clinical Appropriateness)

FFE, state performing plan management functions

Non-Discrimination (Cost-Sharing)

FFE

Non-Discrimination (Formulary Outlier)

FFE, state performing plan management functions

Non-Discrimination (Treatment Protocol Calculator)

FFE

Network Adequacy

FFE, state performing plan management functions

Network Breadth

Issuers in states participating in the Network Breadth Pilot (TN, TX)


Plan ID Crosswalk

FFE, state performing plan management functions, SBE-FP

Program Attestations

FFE

Quality Improvement Strategy (QIS)

FFE, state performing plan management functions

Quality Rating System (QRS)

FFE, state performing plan management functions

Service Area (Including Partial County)

FFE

Silver/Gold

FFE

Rolling review results released daily, starting approximately one week after the Early Bird deadline.

Stand-Alone Dental Plan (SADP) Actuarial Value (AV) Supporting Documents

FFE

SADP Essential Health Benefit (EHB) Benchmark

FFE

SADP EHB Supporting Documents

FFE

Standardized Plan Options

FFE, state performing plan management functions, SBE-FP

Rolling review results released daily, starting approximately one week after the Early Bird deadline.

Transparency in Coverage

FFE, state performing plan management functions, SBE-FP

Transparency in Coverage URLs

FFE, state performing plan management functions, SBE-FP

Rolling review results released daily, starting after the initial submission deadline.