Chapter 1: Administrative Application Section
Contents
1. 80 Enrollment 81 Claims Processing 82 Edge Server Host 79 Do you have a TPA for the following processes Yes Yes No Complete the following fields in the Administrative Template l Enable template macros using the Options button on the Security Warning toolbar and select Enable this content If macros are not enabled before entering data the template will not recognize the data and they will have to reenter HIOS Issuer ID required Enter your five digit HIOS issuer ID if not prepopulated Proposed Exchange Market required Use the drop down menu to select the correct proposed exchange market Individual SHOP or Both An application can be associated with both an Individual market plan and SHOP If you intend to offer both Individual and SHOP plans in the FFM select Both An issuer should not fill out two separate applications submitting a second Administrative Template overwrites the first submission in HIOS Issuer State required Select the state in which you propose to offer coverage using the drop down menu Version 2 1 5 2015 QHP Application Instructions 5 Current Sales Market required Select the markets in which you currently sell products using the drop down menu a If you are not currently selling products in either the Individual or SHOP markets select Both 6 Administrative Data Section 1 Enter administrative data a CompanyLlegal Name required Enter th2. instructions below to complete the Administrative Template Figures 1 2 through 1 5 show samples of completed Administrative Template sections The 2015 version of the template must be used The banner section of each template will specify 2015 Version 2 1 3 2015 QHP Application Instructions Figure 1 2 Administrative Template Sections 1 through 4 Py ________ 8 The QHP Application requires submission of certain administrative data that will be utilized for operational purposes This information includes identifying information and contact information Some of this information will be pre populated based on the information you have previously entered in HIOS All fields marked with an asterik are required Depending on the Proposed Exchange Market Coverage selected certain additional fields may be required On validation missing or incorrect data is highlighted To validate the template use the Validate button or press Ctrl Shift V To finalize the template press the finalize button or press Ctrl Shift F 2015 Administrative Data v4 0 Validate c Proposed Exchange Market Coverage D SHOP Small Group 1 2 3 4 Finalize 5 6 7 9 1 Administrative Data E 10 Company Legal Name Issuer Legal Name Issuer Marketing Name 11 Maryland Insurance Company DKS MIC Md Ins Co 12 13 Associated Health Plan ID TINS NAIC Company Code NAIC Group Code 14 1234567890 52
3. service URL Version 2 1 7 2015 QHP Application Instructions i Use your Customer service phone number if there is no 10 digit TTY number ii The customer service phone number toll free number and TTY need to be final as entered into the QHP Application but the numbers themselves do not need to be live until open enrollment Enter a phone extension for your Individual market customer service contact if applicable If the phone extension begins with a zero copy and paste the number from another Excel document format the cell in the other Excel document as text into the cell it will be accepted and pass validation do not type a phone extension beginning with a zero directly into the template because Excel reformats the entry 15 Customer Service SHOP Small Group Section 10 If you chose SHOP as your proposed exchange market enter your customer service contact a Enter the proposed SHOP market coverage customer service phone toll free number TTY and customer service URL i Use your Customer service phone number if there is no 10 digit TTY number ii The customer service phone number toll free number and TTY need to be final as entered into the QHP Application but the numbers themselves do not need to be live until open enrollment Enter a phone extension for your SHOP customer service contact if applicable If the phone extension begins with a zero copy and paste the number from another Excel document format
4. the cell in the other Excel document as text into the cell it will be accepted and pass validation do not type a phone extension beginning with a zero directly into the template because Excel reformats the entry 16 Contacts Section 11 Enter other contacts as applicable a Version 2 Contact information is optional but very useful The contacts you provide should reflect the person at the issuer who can answer Department of Health and Human Services HHS questions on the specific topic The contacts are not made public i The User Access Contact is used to identify the single point of contact for addressing issues related to HIOS access ii The Quality Contact is the person who should be contacted for issues related to QHP quality reporting requirements such as accreditation the Quality Rating System and the QHP Enrollee Experience Survey also known as the Enrollee Satisfaction Survey Enter the first name last name phone number and e mail address of each applicable contact 1 8 2015 QHP Application Instructions c Enter a phone extension for each contact if applicable If the phone extension begins with a zero copy and paste the number from another Excel document format the cell in the other Excel document as text into the cell it will be accepted and pass validation do not type a phone extension beginning with a zero directly into the template because Excel reformats the entry d The pharmacy benefit man
5. 0 31 6 Issuer SHOP Small Group Contact 32 First Name Last Name E mail Address Phone Number Phone Extension 33 Susan Smith ssmith mdins org 301 123 4568 34 35 7 CEO 36 First Name Last Name E mail Address Phone Number Phone Extension 37 Betsy Randolph barandolph mdins org 301 123 4569 38 39 8 CFO 40 First Name Last Name E mail Address Phone Number Phone Extension 41 Heny Jones hajones mdins org 301 111 1111 42 43 9 Customer Service Individual Market Customer Service Phone Customer Service Phone Extension Customer Service Toll Free Customer Service TTY Customer Service URL 45 800 123 4569 800 123 4569 866 111 1112 MDINS COM 46 47 10 Customer Service SHOP Small Group 48 Customer Service Phone Customer Service Phone Extension Customer Service Toll Free Customer Service TTY Customer Service URL 49 800 123 4570 800 123 4570 866 111 1113 MDINS SHOP COM Version 2 1 4 2015 QHP Application Instructions Validate 54 Online Enrollment Center Contact 55 Online Enrollment Center Contact Backup Figure 1 4 Administrative Template Section 11 B c o E A 2015 Administrative Data v4 0 The QHP Appiication requires submission of certain administrative data that will be utilized for operational purposes This information includes identitying information and contact information Some of this information mil be pre populated based on the information you have previously entered in MIOS All
6. 2113333 54771 0812 15 16 2 Company Address 17 Address Address 2 optional City States Zip Code 18 2222 Md Insurance Way Suite 2 Hyattsville MD 20784 19 20 3 Issuer Address 22 panes Address 2 optional City State 22 2222 Md Insurance Way Suite 2A Hyattsville MD 23 24 4 Select Your Primary Contact 25 SHOP Small Group ee Figure 1 3 Administrative Template Sections 5 through 10 A B c D E 2015 Administrative Data v4 0 The QHP Application requires submission of certain administrative data that will be utilized for operational purposes This information includes identifying information and contact information validate Some of this information will be pre populated based on the information you have previously entered in HIOS All fields marked with an asterik are required Depending on the Proposed Exchange Market Coverage selected certain additional fields may be required Finalize On validation missing or incorrect data is highlighted NOH Bw nie To validate the template use the Validate button or press Ctrl Shift V To finalize the template press the finalize button or press Ctrl Shift F Issuer ID 12345 Proposed Exchange Market Coverage SHOP Small Group Issuer State MD Current Sales Market Both 27 5 ssuer Individual Market Contact 28 First Name E mail Address Phone Number Phone Extension 29 Ralph Thompson rathompson ddins org 301 123 4567 3
7. Chapter 1 Instructions for the Administrative Application Section Contents Chapter 1 Instructions for the Administrative Application Section ce eceeeeeseesseeeeeeeeees 1 1 MVS TUS WV og aoine a ese ooo E snp ees ep evden nag oes ee 1 1 2 QHP D ta DOTS SAY issiran eredera bes erara e E e a EERE ETS AEE 1 1 OP MUO etae a sates ta tascen gees aete can aece ee E ee E R 1 2 4 Administrative Data Requirement ccccesssscesscecssececsencecsencecesncecsececseeeceeeecseeeeeaeees 1 2 5 Application IMSUCHONS ssec ked eas sasuacdeessudoes saseceddstandead cuanceaavesuegassiaayen 1 2 5 1 Template struction S vs scsiesujvadcesnieaastregsasewnarsentemecssacenesaaasadetieatonnteadsatassaacavedtoasmetsannenvanded 1 3 5 2 Data Update S isse enca ree ea A O ea E A 1 10 1 Overview This section of the Qualified Health Plan QHP Application collects administrative information about the insurance company and any holding company associated with an issuer submitting an application This administrative information is used to support the operations of the Federally facilitated Marketplace FFM including tracking of issues communications and data submission When possible much of the information in this and other sections is prepopulated with data previously submitted to the Health Insurance Oversight System HIOS In this section issuers supply information about their organization They must complete the Administrative Template which con
8. ager and reinsurance contacts do not apply to dental plans 17 Third Party Administrator required Section 12 Identify whether you have third party administrators TPAs by selecting Yes or No as applicable Use the drop down menu to select the correct response This information identifies whether the issuer works with a TPA any vendor that provides services in the functional areas listed indicating Yes does not require that a TPA perform all functions a Enrollment b Claims Processing c Edge Server Host 18 Click the Validate button in the template The template identifies any data issues that require attention Resolve any identified errors and click Validate again Repeat until all errors are resolved 19 Click the Finalize button in the template to create the template document to be uploaded The function creates an XML file It is also recommended to save the template to your hard drive as an XLSM 20 Save the XML file using your default drive or store the file where you will be able to find it to upload to the Administrative Data section of the Issuer Module in the QHP Application system 21 Upload the completed Administrative Template in the Administrative Data section of the Issuer Module in the QHP Application system Version 2 1 9 2015 QHP Application Instructions 5 2 Data Updates Figure 1 6 shows the fields displayed on www healthcare gov Figure 1 6 Plan Compare QHP Landscape Data element Is
9. e company s legal name This may be your parent or holding company If you do not have a parent or holding company your company legal name and issuer legal name are the same b Issuer Legal Name required Enter the issuer s legal name If the Issuer legal name on the template does not match exactly the name associated with your Issuer ID in HIOS the template returns an invalid issuer legal name system error when you upload it c Issuer Marketing Name required Enter any marketing name you use for the plans you offer d Associated Health Plan ID HPID Enter your HPID the controlling HPID for the company licensed to operate within the state if applicable e TIN required Enter your nine digit tax identification number TIN The TIN field accepts nine numbers no hyphen or 10 characters including the hyphen If users enter 10 numbers it will not pass validation f NAIC company code Enter your NAIC company code if applicable g NAIC group code Enter your NAIC group code if applicable 7 Company Address Section 2 Enter company address information a Enter the address city state and ZIP code information as required b Enter any additional address information in the Address 2 field if applicable 8 Issuer Address Section 3 Enter issuer address information a Enter the address city state and ZIP code information as required b Enter any additional address information in the Address 2 field
10. folds marked with an astorik are required Depending on the Proposed Exchange Market Coverage selected certain additional elds may be required Finalize On validation missing or incorrect data is highlighted To validate the template use the Validate Dutton ov press Ctrl Shift V To finalize the piale oress the finalize DUTON or press Cti Shit F Issuer 10 12345 SHOP Small Group Figure 1 5 Administrative Template Section 12 A B c D E 2015 Administrative Data v4 0 mhe QHP Application requires submission of certain administrative data that will be utilized for operational purposes This information includes identifying information and contact information Some ofthis information will be pre populated based on the information you have previously entered in HIOS Validate All fields marked with an asterik are required Depending on the Proposed Exchange Market Coverage selected certain additional fields may be required Finalize On validation missing or incorrect data is highlighted To validate the template use the Validate button or press Ctrl Shift V To finalize the template press the finalize button or press Ctrl Shift F Issuer ID 12345 Proposed Exchange Market Coverage SHOP Small Group Now bw nie 78 12 Third Party Administrator s Issuer State MD Current Sales Market Both
11. if applicable 9 Primary Contact required Section 4 Using the drop down menu select the market Individual or SHOP associated with the person designated as the primary Marketplace contact for your organization 10 Issuer Individual Market Contact section 5 If you chose Individual as your primary contact enter the contact information for the Individual market contact Version 2 1 6 2015 QHP Application Instructions a Enter the first name last name e mail address and phone number of your Individual market contact b Enter a phone extension for your Individual market contact if applicable If the phone extension begins with a zero copy and paste the number from another Excel document format the cell in the other Excel document as text into the cell it will be accepted and pass validation do not type a phone extension beginning with a zero directly into the template because Excel reformats the entry 11 Issuer Small Group Contact Section 6 If you chose SHOP as your primary contact enter the contact information for the SHOP Small Group market contact a Enter the first name last name e mail address and phone number of your SHOP contact b Enter a phone extension for your SHOP contact if applicable If the phone extension begins with a zero copy and paste the number from another Excel document format the cell in the other Excel document as text into the cell it will be accepted and pass validation do n
12. inistrative Template Therefore it is imperative that you ensure the information contained in HIOS is correct and the data fields are populated see Section 4 2 for specific fields displayed on Ne All header fields in the template marked with an asterisk are required All state values must be selected from the drop down menu The template requires you to select a Current Sales Market If you are not currently selling products in either the Individual or SHOP markets select Both in the Current Sales Market field Dual product issuers should submit the primary dental contact where indicated in the Administrative Template and indicate your main customer service line in Section 9 individual market or Section 10 small group Only a single customer service line can be entered Dual product issuers can only enter a single customer service number in HIOS Issuers should communicate directly with members and or route calls regarding dental questions to the right support Issuers should work with their account managers when assigned to indicate additional contact information as appropriate All issuers must complete the Administrative Template When the template is completed issuers must upload it to the Administrative Data section of the Issuer Module in the QHP Application system Using the 2015 version of the template downloaded from the Administrative Data section of the Issuer Module in the QHP Application system follow the
13. nly if Issuer marketing name is blank Yes No No No No No No No No No No Updates to the data displayed for plan compare QHP Landscape and My Account must be completed in HIOS Plan Finder Updates to the Issuer Marketing Name for display in FF SHOP must be completed in the Administrative Template 1 If you need to change your customer service information phone numbers or URL please note the following a You must have a submitter role in HIOS to make changes b Instructions on how to make these changes in the HIOS Plan Finder Module are contained in Section 5 1 of the Health Insurance Oversight System Plan Finder Issuer User Manual at http www cms gov CCHO Resources Forms Reports and Other Resources Downloads hios plan finder issuer user manual pdf 2 If you need to change your Issuer Marketing Name take the following steps you must have an Issuer Administrator role in order to make issuer level changes a Log in to HIOS b Select Manage an Organization on the left hand side of the bar c Enter the FEIN and click Search The issuers associated with the company will display Version 2 1 10 2015 QHP Application Instructions g Select Edit next to the issuer where the change is needed The Issuer Marketing Name is the third data element After making the desired change scroll to the bottom of the page select the Submit button The change is then commi
14. ot type a phone extension beginning with a zero directly into the template because Excel reformats the entry 12 CEO Section 7 Enter the contact information for your CEO contact a Enter the first name last name e mail address and phone number of your CEO contact b Enter a phone extension for your CEO contact if applicable If the phone extension begins with a zero copy and paste the number from another Excel document format the cell in the other Excel document as text into the cell it will be accepted and pass validation do not type a phone extension beginning with a zero directly into the template because Excel reformats the entry 13 CFO Section 8 Enter the contact information for your CFO contact a Enter the first name last name e mail address and phone number of your CFO contact b Enter a phone extension for your CFO contact if applicable If the phone extension begins with a zero copy and paste the number from another Excel document format the cell in the other Excel document as text into the cell it will be accepted and pass validation do not type a phone extension beginning with a zero directly into the template because Excel reformats the entry 14 Customer Service Individual Market Section 9 If you chose Individual as your proposed exchange market enter your customer service contact a Enter the proposed Individual market coverage customer service phone toll free number TTY and customer
15. rmation 1 2 HIOS Issuer ID Issuer state HIOS Product ID for proposed QHPs NAIC company and group codes Taxpayer Identification Number TIN or Employer Identification Number EIN also known as Federal Employer Identification Number FEIN Proposed exchange market coverage Individual Small Business Health Options Program SHOP or both Current sales market Individual SHOP or both Names phone numbers e mail addresses and website addresses i e URLs for company contacts such as CEO CFO and customer service 5 Application Instructions The Administrative section of the QHP Application uses an Excel template to collect issuer administrative information Figure 1 1 shows key items in these instructions for completing the Administrative section Version 2 1 2 2015 QHP Application Instructions Download the latest versions of the Administrative Template from Using the correct template version is critical The current and correct version of template includes 2015 in the banner To initiate the template and allow data entry enable template macros using the Options button on the Security Warning toolbar and select Enable this content The Administrative Template contains 12 sections If you are a registered HIOS user your template may have prepopulated fields that are highlighted in yellow and cannot be changed The data displayed on is pulled from the data contained in HIOS and not the Adm
16. suer ID Issuer State Issuer Address Issuer Legal Name Issuer Marketing Name Customer Service Individual Market Customer Service Phone Customer Service Individual Market Customer Service Phone Extension Customer Servce Individual Market Customer Service Toll Free Customer Service Individual Market Customer Service TTY Customer Service Individual Market Customer Service URL Customer Service SHOP Small Group Customer Service Phone Customer Service SHOP Small Group Customer Service Phone Extension Customer Service SHOP Small Group Customer Service Toll Free Customer Service SHOP Small Group Customer Service TTY Customer Service SHOP Small Group Customer Service URL Displayed on Plan Compare No No No Only if Issuer marketing name is blank Yes Yes Yes if extension exists Yes Yes if different from toll free Yes No No No No No Issuer Marketing Name for SHOP Display is pulled from the Administrative template Displayed on QHP Displayed on Landscape My Account Yes No Yes Yes No Yes Only if Issuer Only if Issuer marketing marketing name is blank name is blank Yes Yes Yes Yes Yes if Yes if extension extension exists exists Yes Yes Yes if different Yes if different from toll free from toll free Yes Yes Yes Yes Yes if Yes if extension extension exists exists Yes Yes Yes if different from toll free Yes Yes if different from toll free Yes SHOP Display No No No O
17. tains items related to the legal entity organization web address National Association of Insurance Commissioners NAIC affiliation proposed market types and company contacts such as chief executive officer CEO chief financial officer CFO and customer service 2 QHP Data Display Some data collected in the Administrative Template is also contained in HIOS The data displayed on www healthcare gov for the individual market is pulled from the data contained in HIOS and not the Administrative Template Therefore it is imperative that you ensure the information contained in HIOS is correct and the data fields are populated see Section 4 2 for specific fields displayed on www healthcare gov However you must still submit a completed Administrative Template with your application The Issuer Marketing Name displayed for the Federally facilitated Small Business Health Options Programs FF SHOP plan is pulled from the Administrative Template Issuers who offer plans in the FF SHOP will need to ensure that their Jssuer Marketing Name is updated both Version 2 1 1 2015 QHP Application Instructions in HIOS and on the Administrative Template If the issuer has not provided an Issuer Marketing Name the Issuer Legal Name name will be displayed 3 Purpose This chapter guides you through completing the Administrative section of your QHP Application 4 Administrative Data Requirements To complete this section you need the following info
18. tted to the database and seen on the screen The Issuer Marketing Name does not need to be changed in the Administrative Template unless you want to change other data elements in the Administrative Template or want to update the FF SHOP display If you want to change other data in the Administrative Template first change the Issuer Marketing Name in the HIOS web edit feature instructions above and then download a new version of the Administrative Template with the revised Issuer Marketing Name prepopulated in the template The template then can be resubmitted into the QHP Issuer Module 3 Other a C Version 2 Instructions on how to update data contained in HIOS but not displayed on www healthcare gov are found at http www cms gov CCHO Resources Forms Reports and Other Resources Downloads hios portal user manual 10 09 2013 pdf If you determine that information in HIOS for the following fields is incorrect you need to submit a change request to the CMS Help Desk Exchange Operations Support Center XOSC at 1 855 CMS 1515 or via e mail at CMS_FEPS CMS HHS gov Specify your issuer ID the updates that need to be made and that the update needs to be made to the data in the HIOS Plan Finder Module i NAIC Company Code ii NAIC Group Code iii Issuer Legal Name iv Issuer Address Updates to contacts should be provided to your account manager when assigned 1 11 2015 QHP Application Instructions
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