QHP Certification

Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations (CMS-10433)

OMB: 0938-1187

IC ID: 206068

Documents and Forms

Document Name Document Type
Form CMS-10433 QHP Certification Form and Instruction
CMS-10433 Administrative Data Template CMS-10433 - Appendix A-Accred-Admin-Screenshots.pdf Form and Instruction
CMS-10433 Administrative Data Template CMS-10433 - Appendix A-Accred-Admin-Screenshots.pdf Form and Instruction
CMS-10433 Plan Benefits Template C_Plan_ID_Crosswalk_Template.pdf Form and Instruction
CMS-10433 Plan Benefits Template C_Plan_ID_Crosswalk_Template.pdf Form and Instruction
CMS-10433 Network ID Template B_URL_Template.pdf Form and Instruction
CMS-10433 Network ID Template B_URL_Template.pdf Form and Instruction
CMS-10433 Plans and Benefits Template D_Plans_and_Benefits_Template.pdf Form and Instruction
CMS-10433 Plans and Benefits Template D_Plans_and_Benefits_Template.pdf Form and Instruction
CMS-10433 Prescriptions Drug Formulary Template E_Perscrption_Drug_Template.pdf Form and Instruction
CMS-10433 Prescriptions Drug Formulary Template E_Perscrption_Drug_Template.pdf Form and Instruction
CMS-10433 Rate Table Template AppG_NONFUNCTIONAL_RateTables.xls Form and Instruction
CMS-10433 Rate Table Template AppG_NONFUNCTIONAL_RateTables.xls Form and Instruction
CMS-10433 Service Area Template I_Service_Area_Template.pdf Form and Instruction
CMS-10433 Service Area Template I_Service_Area_Template.pdf Form and Instruction
CMs-10433 Business Rules Template H_Business_Rules_Template.pdf Form and Instruction
CMs-10433 Business Rules Template H_Business_Rules_Template.pdf Form and Instruction
CMS-10433 QHP Certification Instrument Screenshots J_Interoperability_Compliance_Web_ Form.pdf Form and Instruction
CMS-10433 QHP Certification Instrument Screenshots J_Interoperability_Compliance_Web_ Form.pdf Form and Instruction
CMS-10433 Reinsurance Program and Risk Adjustment Program F_RA_Programs_Payment_Ops_Data.pdf Form and Instruction
CMS-10433 Reinsurance Program and Risk Adjustment Program F_RA_Programs_Payment_Ops_Data.pdf Form and Instruction