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), after data change windows, and through CMS’s post-certification assessment (PCA).

  • 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, PCA, 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 a CMS direct enforcement state) 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. New for plan year (PY) 2022, CMS is releasing updated Cost Sharing Reduction (CSR) – Plan Variation and Data Integrity 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 and Data Integrity 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 throughout a given review cycle. For PY2022, 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. Rolling review areas for PY2022 include CSR – Plan Variation and Data Integrity.
  • 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.

Any time an issuer submits data or a state transfers data, CMS will post updated CSR – Plan Variation and Data Integrity 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.

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

Compliance Plan and Organizational Chart

FFE

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

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

Non-Discrimination (Clinical Appropriateness)

FFE

Non-Discrimination (Cost-Sharing)

FFE

Non-Discrimination (Formulary Outlier)

FFE

Non-Discrimination (Treatment Protocol Calculator)

FFE

Network Breadth

Issuers in states participating in the Network Breadth Pilot (ME, 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

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

FFE

SADP Essential Health Benefit (EHB) Benchmark

FFE

SADP EHB Supporting Documents

FFE

Transparency in Coverage

FFE, state performing plan management functions, SBE-FP


*For PY2022, after the initial and secondary deadlines, the rolling review 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.

^While CMS will conduct the QIS review based on data submitted as of the initial submission deadline, initial round QIS review results will not be shared with issuers until the secondary review round corrections are shared, in early/mid-August. Final round QIS corrections will be shared along with other final round corrections.