Recognized Accrediting Entity Data Requirements, Appendix

Appendix C

Recognized Accrediting Entity Data Requirements
Table C 1. Recognized Accrediting Entity Data Elements to be provided by the
accrediting entity to the Exchange
Data element name
Name of Issuer that has existing accreditation

Data element description
Full name of the State-level legal entity authorized
to do business in the service areas applied for in
the State.
Address of issuer that has existing accreditation
Issuer street address, city, state and zip code
Unique Identifier for the issuer
An accrediting entity assigns an organization
identification number or an application number
(depending on the particular accrediting entity) to
a health care organization that the accrediting
entity deems legally entitled to issue a contract for
health insurance for a defined population
HIOS Issuer ID
The unique 5-digit enumerator that identifies the
company and state or territory combination in
HIOS. This ID will be submitted by the issuer to the
accrediting entity
Accredited market type
The population (Commercial/Medicaid/Exchange)
that is being covered by the issuer’s accredited
product
Accredited product type
The issuer’s product type that is accredited (for
example, HMO, POS, PPO) (if accreditation is
available at the product type level)
Accreditation status
The accreditation status designated by an
accrediting entity to an accredited issuer or
product after the accrediting entity’s review.
Accreditation survey type or level
If the accrediting entity uses different types of
accrediting surveys, the survey type used by the
accrediting entity to review the issuer’s product.
Accreditation score
The accreditation numeric score designated by an
accrediting entity to an accredited issuer or
product after the accrediting entity’s review.
Clinical quality measure results and expiration date The Exchange will need to convey to the
accrediting entity which clinical quality measure
data it needs from the accrediting entity on each
issuer’s product type (if applicable
Consumer Assessment of Health-care Providers
The Exchange will need to convey to the
and Systems (CAHPS) measure results and
accrediting entity which CAHPS composite
expiration date
measure and measure results it needs from the
accrediting entity on each issuer’s product type (if
applicable)