CMS-10433 Service Area Template

Service Area Template
All fields with an asterisk (*) are required
To validate, press the Validate button or Ctrl + Shift + V. To finalize, press the Finalize button or Ctrl + Shift + F
Click Create Service Area IDs button (or Ctrl + Shift + S) to create service area ids based on your state
Service Area IDs will populate in the drop-down box in Service Area ID column
For each row, enter one County for that Service Area ID (unless the Service Area covers entire state)
HIOS Issuer ID:*
Issuer State:*
Service Area ID* Required: Enter the Service Area ID	Service Area Name* Required: Enter the Service Area Name	State* Required: Does this Service Area cover the entire state?	County Name Required if State is "No": Select the County - FIPS this Service Area covers	Partial County Required if State is "No": Does this Service Area include a partial county?	Service Area Zip Code(s) Required if Partial County is "Yes": Enter the zip codes in this county that are covered by this Service Area	Partial County Justification Required if Partial County is "Yes": Enter a Justification of why all of the zip codes are not included in this service area.