CMS-10572 Data Template - Appendix D

OMB Control # 0938-1310
Expiration Date: XX/XX/20XX

Transparency in Coverage Reporting by Qualified Health Plan Issuers
Appendix D: Health Insurance Oversight System (HIOS) via the Supplemental Submission
Module (SSM)
A. The following steps provide an overview of the initial submission process for the Claims
Payment Policies and Practices URL in the Health Insurance Oversight System (HIOS) via
the Supplemental Submission Module (SSM). The URL Data page allows users to review and
update URL data and is divided into three main sections: the Download Issuer URL Template
File section, the Upload Issuer URL Template File section, and the Search & Update URLs
section. Users can choose between two submission methods to submit URLs:
• Submit using a simple URL template, which can be downloaded from the module. If an issuer
is submitting multiple URL types along with the Transparency in Coverage URL, CMS
recommends this method.
• Submit through a Search & Update capability available within the module User Interface
(UI). If an issuer is only submitting the Transparency in Coverage URL, CMS recommends
this method.
1. Download Issuer URL Template file for Transparency in Coverage and then click
Generate Issuer URL Template button.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 0938-1310 (Expires XX/XX/20XX). The time required to
complete a one-time technical modification is estimated to average 11 hours per response for QHP issuers. The time required to complete an
annual submission of Transparency in Coverage data is estimated to average 44 hours per response for QHP issuers. If you have comments
concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn:
PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. ****CMS Disclosure**** Please do not send applications,
claims, payments, medical records or any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any
correspondence not pertaining to the information collection burden approved under the associated OMB control number listed on this form
will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your documents, please contact Jack
Reeves at [email protected].

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2. Click on Download Issuer URL Template File and Update URLs.

3. Upload Issuer URL template file by selecting “Choose File” and navigating to local file
location.

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B. Search and Update URLs to View URL Data Currently Stored in the System and to Make
Quick Updates via a Search Results Table.
1. Select Transparency in Coverage under “Search and Update URLs” dropdown.

2. Use the New URL column in the search results table to submit URL updates.

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