Essential Community Provider and Network Adequacy Data Requirements

Essential Community Provider-Network Adequacy (ECP/NA) Data Collection to Support QHP Certification (CMS-10803)

OMB: 0938-1415

IC ID: 251109

Documents and Forms

Document Name Document Type
Form CMS-10803 Essential Community Provider and Network Adequacy Data Requirements Form and Instruction
CMS-10803 Appendix A CMS-10803_Appendix_A_ECP-NA_Template_508.pdf Form and Instruction
CMS-10803_Appendix_B_ECP-NA_Issuer_Module_Mockup_508.pdf Other-Screenshots
CMS-10803 - Appendix_B_Issuer_Module_Mockup.pdf Appendix B - User Module Mockup IC Document