| Table of Contents | |
| # | Tab Name |
| 1 | Form Information |
| 2 | Background |
| 3 | Document Change Log |
| 4 | Instructions |
| 5 | Pre-Sampling |
| 6 | Policy |
| 7 | Tax Filing |
| 8 | Member Demographics |
| 9 | Verification Events |
| 10 | Verification Inconsistency |
| 11 | Eligibility Events |
| 12 | SEP Manual |
| 13 | Redetermination Events |
| 14 | Enrollment Reconciliation |
| 15 | Plan Management |
| 16 | Data Dictionary |
| 17 | Data Mapping Tool |
| Form Information | |
| Form Name | Improper Payment Pre-Testing and Assessment (IPPTA) Data Request Form (DRF) |
| Form Number | TBD |
| Revision Date | 6/21/2024 |
| PRA Disclosure Statement | 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 0938-1439 (Expires 06/30/2026). This is a mandatory information collection. The time required to complete this information collection is estimated to average 530 hours per response during an IPPTA period, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. 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 Halina DeSantis at halina.desantis@cms.hhs.gov. |
| IPPTA Data Request Form Background |
| Per the Patient Protection and Affordable Care Act (ACA) (Pub. L. 111–148), the Health Care and Education Reconciliation Act (Pub. L. 111–152), and the Payment Integrity Information Act (PIIA) (Pub. L. 116-117), The Centers for Medicare & Medicaid Services (CMS) are to use a systematic method to conduct improper payments measurements for the Health Insurance Exchanges. This includes the Federally Facilitated Exchanges (FFE), State Exchanges using the Federal Platform (SE-FPs) and State Partnership Exchanges (SPEs). This also includes independent State Exchanges (SEs). To prepare SEs for the planned improper payment measurement, CMS is conducting an Improper Payment Pre-Testing and Assessment (IPPTA) Program. To facilitate IPPTA, CMS is requesting that the state Exchange provide (1) Pre-sampling Information and (2) Sampled Unit Data in a uniform format through the use of this IPPTA Data Request Form (DRF). Scenario-based Sampled Unit Data Collection will be used to understand the application population for each State Exchange. After reviewing the pre-sampling data submitted by the SE, CMS will contact the SE to request that the SE submit the application data associated with no fewer than 10 tax households that collectively fulfill the scenarios to be provided to the SE by the CMS RC. The Scenario-based Sampled Unit Data Collection will be used to conduct the IPPTA reviews to determine SE compliance with federal regulations. |
| Document Changelog | |
| Form Name | Improper Payment Pre-Testing and Assessment (IPPTA) Data Request Form (DRF) with Data Mapping Tool (DMT) |
| Form Number | TBD |
| Revision Date | Description of Changes |
| 5/10/2024 | Included "Data Mapping Tool" tab, Created "Document Change Log" tab |
| 5/15/2024 | Updated "Instructions" tab, with entry for Data Mapping Tool |
| 5/29/2024 | Created a "DRF Table of Contents" tab, including a table of contents. |
| 5/29/2024 | Moved up the "Document Change Log" tab to the fourth tab. |
| 5/30/2024 | Added a new column "Policy Applied APTC Amount" and updated the column L to reflect that the column is reserved for and filled out by SBE in the "Pre-Sampling" tab. |
| 5/30/2024 | Altered 'FTR PDM Scheduled Date' Element Detail within 'Data Dictionary' tab of the DRF to reflect 'N/A'. Previous language stated that 'There should be at least one date scheduled for Death PDM.' |
| 5/31/2024 | Added eight (8) information elements ('Auto Re-Enrolled For Past 2 Benefit Years', 'Enrollee Tax Return Access Authorization', 'Failure to Reconcile Indicator', 'IRS Annual Tax Household Income Amount', 'IRS Income Data Available', 'IRS Tax Form Receipt', 'No IRS Data For Past 3 Benefit Years', 'No Updates to Application For Past 2 Benefit Years') to the 'Data Dictionary' and 'Redetermination Events' tabs to account for 'Verify Enrollee Group Assignments' review. |
| 6/20/2024 | Added new "SSN Inconsistency" column to 'Pre-Sampling' tab, and data dictionary entry |
| Instructions | |
| Note: There are hyperlinks in Column A that can be used to access the different tabs in this workbook. | |
|
|
|
| Tab Name | Instructions |
| Pre-Sampling | The State Exchange (SE) will be asked to populate the IPPTA DRF "Pre-Sampling" tab with the total universe of Exchange Assigned Policy IDs that receive APTC greater than $0, associated with a specified Benefit Year (BY). Please provide the following information associated with these policies under the designated columns within the tab: 1) Map the policies to their associated tax households using a unique identifier, providing the mapping under Column B "Tax Household Grouping Identifier". Note: if the SE does not have a designated system identifier for tax households, please generate a proxy identifier that can represent the tax household. 2) Provide the count of verification inconsistencies by their inconsistency type in Columns C through I. It's acceptable to have values of "Y/N" to indicate whether an inconsistency exists if the SE is not able to provide specific inconsistency counts. 3) Provide the number of tax household members in Column J "Number of Tax Household Members" for each tax household in the list. Note: Column K "Selected For Sample (Filled Out By CMS)" will be filled in by CMS after it has received the requested pre-sampling information from the SE. |
|
|
|
| Tab Name | Instructions |
| Policy | 1) Refer back to Column K "Selected for Sample (Filled Out By CMS)" in the "Pre-Sampling" tab and find the line items where it has been marked by CMS with a "Y". Note the "Tax Household Grouping Identifier" which will be used to populate the columns within this tab. 2) For each of the noted "Tax Household Grouping Identifier", provide all "Application Identifier”, "Application Version", "Application Submission Date", "Person Tracking Number”, and “As-Of-Date” that were submitted for that tax household within the Benefit Year. These six columns constitute the primary key that organizes the tax household by their application submissions for each of their members. It will also be used to link information provided in the other tabs of this workbook. 3) For each of the "Person Tracking Number", with consideration in the context of their "Application Identifier”, "Application Version”, "Application Submission Date" and “As-Of-Date”, provide the requested Policy Information in Columns G through Column O. Note: the "Data Dictionary" tab provides the definitions for each of the requested information elements |
| Tax Filing | 1) Refer back to Column K "Selected for Sample (Filled Out By CMS)" in the "Pre-Sampling" tab and find the line items where it has been marked by CMS with a "Y". Note the "Tax Household Grouping Identifier" which will be used to populate the columns within this tab. 2) For each of the noted "Tax Household Grouping Identifier", provide all "Application Identifier”, "Application Version", "Application Submission Date", "Person Tracking Number”, and “As-Of-Date” that were submitted for that tax household within the Benefit Year. These six columns constitute the primary key that organizes the tax household by their application submissions for each of their members. It will also be used to link information provided in the other tabs of this workbook. 3) For each of the "Person Tracking Number", with consideration in the context of their "Application Identifier”, "Application Version”, "Application Submission Date" and “As-Of-Date”, provide the requested Tax Filing Information in Columns G through Column K. Note: the "Data Dictionary" tab provides the definitions for each of the requested information elements |
| Member Demographics | 1) Refer back to Column K "Selected for Sample (Filled Out By CMS)" in the "Pre-Sampling" tab and find the line items where it has been marked by CMS with a "Y". Note the "Tax Household Grouping Identifier" which will be used to populate the columns within this tab. 2) For each of the noted "Tax Household Grouping Identifier", provide all "Application Identifier”, "Application Version", "Application Submission Date", "Person Tracking Number”, and “As-Of-Date” that were submitted for that tax household within the Benefit Year. These six columns constitute the primary key that organizes the tax household by their application submissions for each of their members. It will also be used to link information provided in the other tabs of this workbook. 3) For each of the "Person Tracking Number", with consideration in the context of their "Application Identifier”, "Application Version”, "Application Submission Date" and “As-Of-Date”, provide the requested Member Demographic Information in Columns G through Column Y. Note: the "Data Dictionary" tab provides the definitions for each of the requested information elements |
| Verification Events | 1) Refer back to Column K "Selected for Sample (Filled Out By CMS)" in the "Pre-Sampling" tab and find the line items where it has been marked by CMS with a "Y". Note the "Tax Household Grouping Identifier" which will be used to populate the columns within this tab. 2) For each of the noted "Tax Household Grouping Identifier", provide all "Application Identifier”, "Application Version", "Application Submission Date", "Person Tracking Number”, and “As-Of-Date” that were submitted for that tax household within the Benefit Year. These six columns constitute the primary key that organizes the tax household by their application submissions for each of their members. It will also be used to link information provided in the other tabs of this workbook. 3) For each of the "Person Tracking Number", with consideration in the context of their "Application Identifier”, "Application Version”, "Application Submission Date" and “As-Of-Date”, provide the requested Verification Events Information in Columns G through Column CH. Note: the "Data Dictionary" tab provides the definitions for each of the requested information elements |
| Verification Inconsistency | 1) Refer back to Column K "Selected for Sample (Filled Out By CMS)" in the "Pre-Sampling" tab and find the line items where it has been marked by CMS with a "Y". Note the "Tax Household Grouping Identifier" which will be used to populate the columns within this tab. 2) For each of the noted "Tax Household Grouping Identifier", provide all "Application Identifier”, "Application Version", "Application Submission Date", "Person Tracking Number”, and “As-Of-Date” that were submitted for that tax household within the Benefit Year. These six columns constitute the primary key that organizes the tax household by their application submissions for each of their members. It will also be used to link information provided in the other tabs of this workbook. 3) For each of the "Person Tracking Number", with consideration in the context of their "Application Identifier”, "Application Version”, "Application Submission Date" and “As-Of-Date”, provide the requested Verification Inconsistency Information in Columns G through Column AK. 4) For fields "Relevant Consumer Documents" and "All Consumer Documents", CMS is requesting information on the relevant consumer documents that were used to resolve the inconsistency as well as all consumer documents that were submitted by the consumer regardless of whether it was used for resolution, respectively. CMS would like to receive copies of these consumer documents for review and will work with the SE to submit data via a secured method. Note: the "Data Dictionary" tab provides the definitions for each of the requested information elements |
| Eligibility Events | 1) Refer back to Column K "Selected for Sample (Filled Out By CMS)" in the "Pre-Sampling" tab and find the line items where it has been marked by CMS with a "Y". Note the "Tax Household Grouping Identifier" which will be used to populate the columns within this tab. 2) For each of the noted "Tax Household Grouping Identifier", provide all "Application Identifier”, "Application Version", "Application Submission Date", "Person Tracking Number”, and “As-Of-Date” that were submitted for that tax household within the Benefit Year. These six columns constitute the primary key that organizes the tax household by their application submissions for each of their members. It will also be used to link information provided in the other tabs of this workbook. 3) For each of the "Person Tracking Number", with consideration in the context of their "Application Identifier”, "Application Version”, "Application Submission Date" and “As-Of-Date”, provide the requested Eligibility Events Information in Columns G through Column AJ. Note: the "Data Dictionary" tab provides the definitions for each of the requested information elements |
| SEP Manual | 1) Refer back to Column K "Selected for Sample (Filled Out By CMS)" in the "Pre-Sampling" tab and find the line items where it has been marked by CMS with a "Y". Note the "Tax Household Grouping Identifier" which will be used to populate the columns within this tab. 2) For each of the noted "Tax Household Grouping Identifier", provide all "Application Identifier”, "Application Version", "Application Submission Date", "Person Tracking Number”, and “As-Of-Date” that were submitted for that tax household within the Benefit Year. These six columns constitute the primary key that organizes the tax household by their application submissions for each of their members. It will also be used to link information provided in the other tabs of this workbook. 3) For each of the "Person Tracking Number", with consideration in the context of their "Application Identifier”, "Application Version”, "Application Submission Date" and “As-Of-Date”, provide the requested SEP Manual Verification Information in Columns G through Column V. 4) For fields "Relevant Consumer Documents" and "All Consumer Documents", CMS is requesting information on the relevant consumer documents that were used to resolve the SEP manual verification as well as all consumer documents that were submitted by the consumer regardless on whether it was used for resolution, respectively. CMS would like to receive copies of these consumer documents for review and will work with the SE to submit data via a secured method. Note: the "Data Dictionary" tab provides the definitions for each of the requested information elements |
| Redetermination Events | 1) Refer back to Column K "Selected for Sample (Filled Out By CMS)" in the "Pre-Sampling" tab and find the line items where it has been marked by CMS with a "Y". Note the "Tax Household Grouping Identifier" which will be used to populate the columns within this tab. 2) For each of the noted "Tax Household Grouping Identifier", provide all "Application Identifier”, "Application Version", "Application Submission Date", "Person Tracking Number”, and “As-Of-Date” that were submitted for that tax household within the Benefit Year. These six columns constitute the primary key that organizes the tax household by their application submissions for each of their members. It will also be used to link information provided in the other tabs of this workbook. 3) For each of the "Person Tracking Number", with consideration in the context of their "Application Identifier”, "Application Version”, "Application Submission Date" and “As-Of-Date”, provide the requested Redetermination Event Information in Columns G through Column Z. Note: the "Data Dictionary" tab provides the definitions for each of the requested information elements |
| Enrollment Reconciliation | 1) Refer back to Column K "Selected for Sample (Filled Out By CMS)" in the "Pre-Sampling" tab and find the line items where it has been marked by CMS with a "Y". Note the "Tax Household Grouping Identifier" which will be used to populate the columns within this tab. 2) For each of the noted "Tax Household Grouping Identifier", provide all "Application Identifier”, "Application Version", "Application Submission Date", "Person Tracking Number”, and “As-Of-Date” that were submitted for that tax household within the Benefit Year. These six columns constitute the primary key that organizes the tax household by their application submissions for each of their members. It will also be used to link information provided in the other tabs of this workbook. 3) For each of the "Person Tracking Number", with consideration in the context of their "Application Identifier”, "Application Version”, "Application Submission Date" and “As-Of-Date”, provide the requested Enrollment Reconciliation Event Information in Columns G through Column W. Note: the "Data Dictionary" tab provides the definitions for each of the requested information elements |
| Plan Management | 1) Refer back to Column K "Selected for Sample (Filled Out By CMS)" in the "Pre-Sampling" tab and find the line items where it has been marked by CMS with a "Y". Note the "Tax Household Grouping Identifier" which will be used to populate the columns within this tab. 2) For each of the noted "Tax Household Grouping Identifier", provide all "Application Identifier”, "Application Version", "Application Submission Date", "Person Tracking Number”, and “As-Of-Date” that were submitted for that tax household within the Benefit Year. These six columns constitute the primary key that organizes the tax household by their application submissions for each of their members. It will also be used to link information provided in the other tabs of this workbook. 3) For each of the "Person Tracking Number", with consideration in the context of their "Application Identifier”, "Application Version”, "Application Submission Date" and “As-Of-Date”, provide the requested QHP Information in Columns G through Column L. Note: the "Data Dictionary" tab provides the definitions for each of the requested information elements |
| All Consumer Documents | After completing all of the tabs mentioned above, the SE should provide CMS with the consumer submitted documents for each sample. The consumer submitted documents will be used to review the APTC for each sample. |
| Data Mapping Tool | The Data Mapping Tool allows the Exchange to provide the "Data Element" contained in the SE's internal system that matches the required "Information Element" for review in the Data Request Form. Note, the tool is organized by SEIPM IPPTA Review Area, the SE is asked to only populate the identified blue cells, as all grey cells are previously requested elements and will be populated automatically to reduce burden. The SE may specify proxy identifiers in the event that a direct match between "Data Element" and requested "Information Element" is not available. The SE may also include notes where useful. |
| Data Dictionary | Definitions for the requested information on any of the tabs can be found by searching under Column A "Information Element". The definition for each Information Element can also be accessed using hyperlinks throughout this workbook. |
| Tax Filing Information | ||||||||||
| Primary Key | Tax Filing Information | |||||||||
| Tax Household Grouping Identifier | Application Identifier | Application Version | Application Submission Date | Person Tracking Number | As-Of Date | Multiple Tax Household Indicator | Tax Filing Status | Tax Filer Indicator | Tax Dependent Indicator | Member Association Role Type |
| Eligibility Events | |||||||||||||||||||||||||||||||||||
| Primary Key | QHP Residency Eligibility | QHP Eligibility | APTC Eligibility | Max APTC Calculation | Auto Re-Enrollment | SEP Eligibility | |||||||||||||||||||||||||||||
| Tax Household Grouping Identifier | Application Identifier | Application Version | Application Submission Date | Person Tracking Number | As-Of Date | QHP Residency Eligibility Determination Date | QHP Residency Eligibility Indicator | QHP Residency Eligibility Reason | Residency Inconsistency Manual Adjudication Conducted | QHP Eligibility Determination Date | QHP Eligibility Indicator | QHP Eligibility Reason | APTC Eligibility Date | APTC Eligibility Indicator | APTC Eligibility Reason | Special Rule For Non-Citizens Override Indicator | FPL Percentage Per Attested Income | Federal Poverty Level Amount | Second Lowest Cost Silver Plan Premium Amount | Member-Level Allocated APTC Amount | Maximum APTC Amount | Auto Re-Enrollment Eligible Indicator | Auto Re-Enrollment Denial Reason | Exchange Applied SEP Indicator | Exchange Applied SEP Start Date | Exchange Applied SEP End Date | Exchange Applied SEP Determination Date | SEP Eligibility Indicator | SEP Type | SEP Eligibility Start Date | SEP Eligibility End Date | SEP Eligibility Determination Date | SEP Auto-Verification Inconsistency Result | SEP Inconsistency Identifier | SEP Manual Adjudication Indicator |
| Plan Management | |||||||||||
| Primary Key | QHP Information | ||||||||||
| Tax Household Grouping Identifier | Application Identifier | Application Version | Application Submission Date | Person Tracking Number | As-Of Date | Selected Insurance Plan Identifier | Plan Certified Indicator | Plan Year | QHP Suppression Date | QHP Unsuppression Date | QHP Suppression Reason |
| Data Dictionary | |||||
| Information Element | Element Definition | Element Detail | Format | Length | Example |
| Adjudication History | A description of the history of adjudicating an inconsistency. | This is a free text field that provides a narrative of the end-to-end chronology of events associated with an inconsistency to enhance the interpretation of the events related to adjudicating the inconsistency. The field will contain, but are not limited to the following elements: - The current status of the inconsistency type being reviewed. - The date the issue was submitted. - The inconsistency that was created and the Clock End Date that was associate with the task. - The list of documents that were submitted by the consumer and the dates they were submitted. - The Adjudication Date. |
Alphanumeric | 1000 | "This inconsistency was resolved on 01-01-2020 using an I-551 card. DHS SAVE was not used." |
| Non-Citizen ID Indicator | Indicates whether the consumer provided an Non-Citizen ID. | Indicator of whether the DMI was adjudicated using the consumer Non-Citizen ID. Possible values are: - "Yes – Non-Citizen ID number was used to resolve the issue." - "No – Non-Citizen ID number was not used to resolve the issue." |
Alphanumeric | 100 | "Yes – Non-Citizen ID number was used to resolve the issue", "No – Non-Citizen ID number was not used to resolve the issue" |
| All Consumer Documents | A list of all consumer documents received by the Exchange associated to the members of an application, including the type(s) of documents received, the date(s) the documents were received and the mode they were received. If providing multiple documents, please separate document by semi-colon |
N/A | Alphanumeric | 1000 | "I-551 Card (Received on 01-01-2020) via Mailroom, Passport (Received on 02-01-2020) uploaded to web site, 1040 (Received on 03-01-2020) via Mailroom" |
| Annual Income Inconsistency | The number of annual income verification inconsistencies that were associated to a tax household for a given plan year. Note: if SE cannot provide a specific count, then a "Y/N" value is acceptable to indicate that an inconsistency type exists for the tax household | N/A | Numeric | 3 | "1", "8", "Y", "N" |
| Application Creation Date | A field that is used to reflect the date that an application was created prior to being submitted. | This date associates to a unique application version. | Date | 9 | "12JAN2021" |
| Application Enrollment Period Type | The enrollment period for the creation of the application. | Enrollment period includes: - Open Enrollment - Special Enrollment |
Alphanumeric | 100 | "Open Enrollment", "Special Enrollment" |
| Application Event Source | The origin event that led to the creation or change, update to an application. | The application can be originated from any of the following sources: - Consumer online submission - Issuer direct enrollment - Submission from third parties - Inbound account transfer - Manual verification worker - Appeals group - Other Note: Application submission from third parties include those events originated from agents, brokers, navigators or assisters, call center workers etc.. |
Alphanumeric | 100 | "Consumer online submission" |
| Application Event Type | The different types of events that led to the creation or change, update to an application. | Application events types include: - Initial Application - Change in Circumstances (aka. Change Report) - Period Data Matching (PDM) for Death - PDM for Medicare - PDM for Medicaid and CHIP - PDM for Failure to Reconcile (FTR) - Auto Re-enrollment - Updates as a result of manual verification - Updates as a result of appeal - Other |
Alphanumeric | 100 | "Initial Application" |
| Application Identifier | A unique identifier for an application household (or households) during a given Plan / Benefit Year. |
In the event that a given tax household is represented among two or more applications or policies for QHP/APTC eligibility within a specific Plan / Benefit Year, CMS would want to be able to map all related applications pertaining to the same tax household. If an Exchange does not have such an identifier at the household level, this identifier should be created for each sample. |
Alphanumeric | 100 | "A123456", "12345678", "A1-2024-MD" -- (an example of a generated Application Identifier for the Plan Year 2024 review for the state of MD) |
| Application Submission Date | A field that is used to reflect the date that an application was submitted. | This date associates to a unique application. | Date | 9 | "12JAN2021" |
| Application Version | A sequence number that is used to distinguish various events for an application, i.e. the creation and subsequent changes or updates made to an application during a Plan / Benefit Year. | There are often multiple application versions that associate to a given application due to any number of events that may occur throughout the Plan / Benefit Year (e.g. reports of Change in Circumstance, Periodic Data Matching, Redeterminations of Eligibility, etc.). In the event an Exchange uses unique identifiers, such as Physical and Logical Application and Policy IDs, to distinguish these events from the same household, the Exchange is expected to apply sequence numbers for each of these events. An alternative might be using dates for the new policies resulted from application events. |
Alphanumeric | 100 | "1", "2", "01/22/2020" |
| APTC Eligibility Date | Date when the APTC eligibility was determined for an application member. | N/A | Date | 9 | "12JAN2021" |
| APTC Eligibility Indicator | Indicates if member is eligible for APTC. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| APTC Eligibility Reason | Reason for how the given APTC eligibility determination was reached. | N/A | Alphanumeric | 100 | "Applicant has employee sponsored coverage (ESC)", "Income is out of FPL range", "Applicant meets all APTC eligibility criteria" |
| Attempt Made to DHS SAVE Indicator | Indicates whether the Manual Adjudicator made an attempt to DHS SAVE. | Indicator of whether the inconsistency was adjudicated per a search in DHS SAVE using the consumer provided Non-Citizen ID or I-94 number. Values for this field are: - Yes – DHS SAVE was used to resolve the issue. - No – DHS SAVE was not used to resolve the issue. |
Alphanumeric | 100 | "Yes – DHS SAVE was used to resolve the issue", "No – DHS SAVE was not used to resolve the issue" |
| Attested Non-ESC MEC Type | The applicant's attestation of the specific Non-ESC MEC type that they currently hold or plan to hold during the benefit year. | N/A | Alphanumeric | 100 | "VA", "Medicaid/CHIP", "Medicare", "Peace Corp", "Tricare" |
| Attested Annual Household Income | The amount of annual income an applicant attested to on the application. | N/A | Decimal | 10 | "60000" |
| Attested Circumstance Change Date | The date the circumstance change occurred. | N/A | Date | 9 | "12JAN2021" |
| Attested Circumstance Change Type | The circumstance change type attested by the applicant. |
N/A | Alphanumeric | 100 | "Adoption", "Newborn", "Marriage", "Relocation", "Loss of MEC" |
| Attested Citizenship Status Indicator | Indicates whether applicant attests he/she is a US citizen. | This indicator associates to each unique member on the application. | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Attested Coverage Request | An indicator that the application member attested to applying for coverage. | This indicator associates to each unique member on the application. | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Attested ESC Offer | Indicates whether an applicant is eligible for Employer Sponsored health coverage. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | This indicator associates to the tax household on the application. | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Attested Incarceration Pending Disposition Indicator | Indicates whether an applicant attested to being in pending disposition for incarceration. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Attested Incarceration Status Indicator | Indicates whether an applicant attested to being incarcerated. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Attested Information Change Reported Indicator | Indicates that the insurance applicant understands that changed information needs to be reported. | Changed information can include but not limited to: * Member demographic information * Life events (e.g., marriage, adoption) * Annual income increase/decrease * Lawful presence status change |
Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Attested Lawfully Present Status Indicator | Indicates whether an applicant attests to being lawfully present. | This indicator associates to each unique member on the application. | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Attested No Fixed Address | Indicates whether an applicant has no fixed address. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Attested Non-ESC MEC Offer | Indicates whether the applicant attests to being enrolled in non-employer sponsored health coverage. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Attested Non-Perjury Indicator | Indicates that the insurance applicant certifies that attestations are true under penalty of perjury. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Attested Person Recognized Tribe Indicator | Indicates if a person attested to being a member of a federally recognized tribe, band, nation, or community. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Attested Tax Household Size | Attested number of individuals in the application related to tax filer members. | N/A | Integer | 10 | "2" |
| Attested Temporary Absence | Indicates whether this application member attests to living outside of the state temporarily. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Auto Re-Enrolled For Past 2 Benefit Years | Indicates whether an application member was auto re-enrolled in the past two benefit years. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Auto Re-Enrollment Denial Reason | The reason an application member was denied auto re-enrollment and APTC Eligibility is terminated. | N/A | Alphanumeric | 100 | "Failure to provide sufficient documentation to allow Auto-reenrollment" |
| Auto Re-Enrollment Eligible Indicator | Indicates whether an application member has passed the state exchange's auto re-enrollment criteria. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Birth Date | Birth date of an application member. | N/A | Date | 9 | "12JAN2021" |
| Chosen for ESC Sampling | Applicant was selected as a part of the statistically significant subset and will be verified via the sampling process. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Citizenship Inconsistency | The number of citizenship verification inconsistencies that were associated to a tax household for a given plan year. Note: if SE cannot provide a specific count, then a "Y/N" value is acceptable to indicate that an inconsistency type exists for the tax household | N/A | Numeric | 3 | "1", "8", "Y", "N" |
| Citizenship Inconsistency Manual Adjudication Conducted | Indicates whether a citizenship verification inconsistency was manually adjudicated. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Citizenship Verification Date | Date when verification of citizenship attestation was conducted. | This date associates to each unique member on the application. | Date | 9 | "12JAN2021" |
| Citizenship Verification Reason | The findings used to set the final verification result in corroborating the consumer’s attestation. | Reasons for the verification result can vary depending on the verification logic used by the Exchange. For example, the reason could be ‘Inconsistent with External Data Source’ if the verification logic is simply using a basic comparison of the consumer’s attestation with those observed from the external data source. If the consumer does not exactly match the external data source, then the consumer receives a Verification Result of ‘Inconsistent’. | Alphanumeric | 1000 | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information", "Applicant attestation was over set thresholds" |
| Citizenship Verification Result | The final determination on whether the Exchange was able to verify the consumer’s attestation. | The verification result should clearly indicate if the verification was successful in verifying the attestation, or if inconsistency was found. | Alphanumeric | 100 | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" |
| Consumer Documents Expiration Date | Date of expiry of the consumer submitted document. | N/A | Date | 9 | "12JAN2021" |
| Consumer Documents Issue Date | Date of issuance of the consumer submitted document. | N/A | Date | 9 | "12JAN2021" |
| Consumer Documents Reflected in Manual Income Verification Result | Consumer documents reflected in standard or custom tool / method / process for manual verification. | This may not be applicable to Exchanges. |
Alphanumeric | 1000 | "1040" |
| Consumer Income Document Effective End Date | The effective end date of the income document as submitted by the consumer. | This field could be used to understand the effective date range of the income document. This field may not be applicable to all Exchanges. | Date | 9 | "12JAN2021" |
| Consumer Income Document Effective Start Date | The effective start date of the income document as submitted by the consumer. | This field could be used to understand the effective date range of the income document. This field may not be applicable to all Exchanges. | Date | 9 | "12JAN2021" |
| Consumer Income Documented Amount | The amount of total annual tax income of the tax household calculated by the inconsistency verification worker based on documentation the applicant provided. | Examples of income sources could be from an employer pay stub, 1040, etc. | Decimal | 10 | "60000" |
| Coverage 60 Days Before Marriage Indicator | Indicates whether the application member attested to having MEC within 60 days before the attested marriage date. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Coverage 60 Days Before Move Indicator | Indicates whether the application member attested to having MEC within 60 days before the attested move date | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Death Data Present | SSA indicated that applicant is associated with death data. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Death Date | Death date of applicant. | N/A | Date | 9 | "12JAN2021" |
| Death PDM Actual Run Date | Date when Death PDM was executed for application member. | N/A | Date | 9 | "12JAN2021" |
| Death PDM Scheduled Date | The date during the benefit year when the Death PDM is scheduled to occur. | There should be at least one date scheduled for Death PDM. | Date | 9 | "12JAN2021" |
| Death Resolution Status | Status used to indicate whether or not an applicant has resolved death-related issues with application. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| DHS SAVE Manual Verification Indicator | An indicator that reflects whether DHS SAVE (Systematic Non-Citizen Verification for Entitlements) was used to manually verify an applicant's attestation of lawful presence status. - N/A – The inconsistency was not related immigration status. - Yes Successful – Non-Citizen ID was provided by consumer and lawful presence was determined = Yes using DHS SAVE. - Not Successful – Non-Citizen ID was provided but lawful presence could not be verified. - Not Attempted – Non-Citizen ID was either: - Not provided and not used - Provided but not used for resolution |
DHS SAVE is a Third Party Data Source that is used when performing electronic verification (Step 1). Steps 2 and 3 may be used during the manual verification process to verify applicants' lawful presence status. - N/A – The inconsistency was not related immigration status. - Yes Successful – Non-Citizen ID was provided by consumer and lawful presence was determined = Yes using DHS SAVE. - Not Successful – Non-Citizen ID was provided but lawful presence could not be verified. - Not Attempted – Non-Citizen ID was either: - Not provided and not used - Provided but not used for resolution |
Alphanumeric | 100 | "N/A", "Yes Successful", "Not Successful", "Not Attempted" |
| Eligible for ESC Sampling | The applicant is eligible to be added to the ESC sampling frame. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Enrollee Tax Return Access Authorization | Indicates whether the tax data used in the application can be used at the time of renewal. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| ESC Data Found | Indicates whether or not ESC verification data was found in the data source. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| ESC Data Source | The external data source that is used to verify the ESC attestation. | N/A | Alphanumeric | 100 | "Office of Personnel Management", "Employer Sampled Information" |
| ESC Inconsistency Manual Adjudication Conducted | Indicates whether an ESC verification inconsistency was manually adjudicated. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| ESC MEC Inconsistency | The number of ESC MEC verification inconsistencies that were associated to a tax household for a given plan year. Note: if SE cannot provide a specific count, then a "Y/N" value is acceptable to indicate that an inconsistency type exists for the tax household | N/A | Numeric | 3 | "1", "8", "Y", "N" |
| ESC Meets MEC and Affordability Standards-based on employer verified premium amount | Indicates whether consumers ESC meets Minimum Essential Coverage (MEC) and Affordability standards based on employer verified premium amount | N/A | Alphanumeric | 11 | "True", "False", "Yes", "No", "Y", "N" |
| ESC Meets MEC and Affordability Standards-based on attested premium amount | Indicates whether consumers ESC meets Minimum Essential Coverage (MEC) and Affordability standards based on consumer attested premium amount | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| ESC Verification Result-Attested | Indicator denoting the verification result of attested ESC MEC. | N/A | Alphanumeric | 10 | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found", "Hold" |
| ESC Verification Result-Employer Verified | Indicator denoting the verification result of employer stated ESC coverage. | N/A | Alphanumeric | 10 | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found", "Hold" |
| ESC Verification Determination Date-Attested | Date when verification of ESC MEC attestation was conducted. | This date associates to each unique member on the application. | Date | 9 | "12JAN2021" |
| ESC Verification Determination Date-Employer Verified | Date when Employer ESC MEC verification was conducted. | This date associates to each unique member on the application. | Date | 9 | "12JAN2021" |
| ESC Verification Reason-Attested | The findings used to set the final verification result in corroborating or disagreeing with the consumer’s attestation. | Reasons for the verification result can vary depending on the verification logic used by the Exchange. For example, the reason could be ‘Inconsistent with External Data Source’ if the verification logic is simply using a basic comparison of the consumer’s attestation with those observed from the external data source. If the consumer does not exactly match the external data source, then the consumer receives a Verification Result of ‘Inconsistent’. | Alphanumeric | 1000 | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information", "Applicant attestation was over set thresholds" |
| ESC Verification Reason-Employer Verified | The findings used to set the final verification result in corroborating or disagreeing with the employer verified ESC coverage. | Reasons for the verification result can vary depending on the verification logic used by the Exchange. For example, the reason could be ‘Inconsistent with External Data Source’ if the verification logic is simply using a basic comparison of the consumer’s attestation with those observed from the external data source. If the consumer does not exactly match the external data source, then the consumer receives a Verification Result of ‘Inconsistent’. | Alphanumeric | 1000 | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information", "Applicant attestation was over set thresholds" |
| Escalation Guidance | Indicates whether an application was escalated to proper authorities for review and guidance. | This may not apply to all Exchanges. | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Essential Health Benefits Policy Premium Amount | Essential Health Benefits (EHB) policy premium amount in a given month. | N/A | Decimal | 10 | "2000" |
| Exchange Applied SEP Determination Date | The date that the exchange applied SEP was determined for the application version. | N/A | Date | 9 | "12JAN2021" |
| Exchange Applied SEP End Date | The date that the exchange applied SEP ended or will end. | N/A | Date | 8 | "12JAN2021" |
| Exchange Applied SEP Indicator | Indicator that marks the SEP that was applied by the exchange. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Exchange Applied SEP Start Date | The date that the exchange applied SEP started or will start. | N/A | Date | 9 | "12JAN2021" |
| Exchange Assigned Policy ID | A unique identifier assigned by the exchange to the insurance policy. | N/A | Alphanumeric | 100 | "12345678" |
| Exchange Benefit End Date | Benefit end date for the QHP coverage period as reflected by Exchange records. | N/A | Date | 9 | "12JAN2021" |
| Exchange Benefit Start Date | Benefit start date for the QHP coverage period as reflected by Exchange records. | N/A | Date | 9 | "12JAN2021" |
| Exchange Effectuation Status | Indicates whether the applicant paid their initial premium for a given policy as indicated by Exchange. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Exchange Policy Applied APTC Amount | The policy applied APTC the Exchange reported in their reconciliation output (RCNO) file that was sent to the issuer. | N/A | Decimal | 10 | "2000" |
| Failure to Reconcile Indicator | Indicates whether the tax household anchor attested that the tax household reconciled to premium tax credits on last year's tax return. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Federal Poverty Level Amount | This is the Federal Poverty Level (FPL), as published on the first day of the regular enrollment period for coverage by a qualified health plan (QHP) through an Exchange for a calendar year, for a family size equal to tax household size without regard to lawful presence status. | FPL guidelines can be found at https://aspe.hhs.gov/poverty-guidelines. | Decimal | 10 | "60000" |
| First Name | First name of application member | N/A | Alphanumeric | 100 | "Sherwin" |
| FPL Percentage Per Attested Income | Income as a percentage of the Federal Poverty Level (FPL) amount, calculated per advanced payment tax credit rules published by the treasury based on information provided by the consumer. | APTC eligible range is 100.00% to 400.00%. | Decimal | 10 | "60000" |
| FTR PDM Actual Run Date | Date when FTR PDM was executed for application member. | N/A | Date | 9 | "12JAN2021" |
| FTR PDM Confirmed Expiration | The applicant has failed to resolve the FTR issue within the given resolution period. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| FTR PDM Confirmed Expiration Date | The date when applicant failed to resolve their FTR issue within the allotted resolution period. | N/A | Date | 9 | "12JAN2021" |
| FTR PDM Scheduled Date | The date during the benefit year when the FTR PDM is scheduled to occur. | N/A | Date | 9 | "12JAN2021" |
| Good Faith Extension | Indicator that reflects whether a good faith extension has been applied to the inconsistency clock end date. | The field could be populated with the following: - The date and time that a Clock End Date was extended, by applying GFE, the reason for the extension. - What the clock End Date was before the GFE was applied and after. - Blank: No GFE |
Alphanumeric | 1000 | "Yes (with original clock end date, extended clock end date, and reason)", "No" |
| Home City | Applicant home city. | N/A | Alphanumeric | 100 | "McLean" |
| Home State Code | Applicant home state code. | N/A | Alphanumeric | 10 | "VA" |
| Home Street Address | Applicant home street address. | N/A | Alphanumeric | 100 | "123 Forrest Street" |
| Home Zip Code | Applicant home zip code. | N/A | Alphanumeric | 10 | "22102" |
| I-94 Number Indicator | Indicates whether the consumer provided an I-94 number. | Indicator of whether the DMI was adjudicated using the consumer I-94 number. Values for this field are: - Yes – I-94 number was used to resolve the issue. - No – I-94 number was not used to resolve the issue. |
Alphanumeric | 100 | "Yes – I-94 number was used to resolve the issue", "No – I-94 number was not used to resolve the issue" |
| Immigration Status Expiration Date | Date when consumer's immigration status expires and needs to be redetermined. | N/A | Date | 9 | "12JAN2021" |
| Incarceration Inconsistency Manual Adjudication Conducted | Indicates whether an Incarceration verification inconsistency was manually adjudicated. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Incarceration Verification Date | Date when verification of incarceration attestation was conducted. | This date associates to each unique member on the application. | Date | 9 | "12JAN2021" |
| Incarceration Verification Reason | The findings used to set the final verification result in corroborating the consumer’s attestation. | Reasons for the verification result can vary depending on the verification logic used by the Exchange. For example, the reason could be ‘Inconsistent with External Data Source’ if the verification logic is simply using a basic comparison of the consumer’s attestation with those observed from the external data source. If the consumer is not found within the external data source, then the consumer's attestation value is used. | Alphanumeric | 1000 | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information" |
| Incarceration Verification Result | The final determination on whether the Exchange was able to verify the consumer’s attestation. | The verification result should clearly indicate if the verification was successful in verifying the attestation, or if inconsistency was found. | Alphanumeric | 100 | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" |
| Income Inconsistency Manual Adjudication Conducted | Indicates whether an Income verification inconsistency was manually adjudicated. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Income Verification Date | Date when verification of income attestation was conducted. | This date associates to the tax household on the application. | Date | 9 | "12JAN2021" |
| Income Verification Reason | The findings used to set the final verification result in corroborating the consumer’s attestation. | Reasons for the verification result can vary depending on the verification logic used by the Exchange. For example, the reason could be ‘Inconsistent with External Data Source’ if the verification logic is simply using a basic comparison of the consumer’s attestation with those observed from the external data source. If the consumer does not exactly match the external data source, then the consumer receives a Verification Result of ‘Inconsistent’. | Alphanumeric | 1000 | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information", "Applicant attestation was over set thresholds" |
| Income Verification Result | Indicator denoting the verification result of an income verification. | N/A | Alphanumeric | 100 | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" |
| Inconsistency Adjudication Date | Date that the manual verification of an inconsistency was concluded. | This field may not be applicable to all Exchanges. | Date | 9 | "12JAN2021" |
| Inconsistency Clock End Date | The clock end date set by the Exchange based on the date the inconsistency was triggered. | N/A | Date | 9 | "12JAN2021" |
| Inconsistency Clock End Date (Alternative) | The clock end date set by the Exchange based on the date the inconsistency was triggered, per alternative source, for example a data warehouse. | N/A | Date | 9 | "12JAN2021" |
| Inconsistency Expiration Date | The date of expiration for an inconsistency, set by the manual verification. | This data is after the consumer submitted the requested documents per the clock end, and indicates a deadline for completing the manual verification. | Date | 9 | "12JAN2021" |
| Inconsistency Identifier | A unique identifier for an inconsistency generated as a result of unsuccessful electronic verifications performed by the Exchange. |
An inconsistency is triggered by the Exchange when the outcome of a verification indicates a discrepancy between the applicant's attestation and the information available from a Trusted Data Source. An inconsistency identifier would be assigned for each event where an inconsistency is triggered by the Exchange. The inconsistency identifier would be specific to each type of inconsistency triggered by the Exchange pertaining to any application member. In the event that an Exchange does not have dedicated inconsistency identifiers to identify unique inconsistencies, the Exchange could create such an identifier as long as it is unique within the sample. |
Alphanumeric | 100 | "123456789" |
| Inconsistency Status | An indicator that reflects the current status. | Statuses include: - Successful manual verification: Inconsistency was resolved and consumer attestation verified. - Unsuccessful manual verification: Inconsistency was not resolved and consumer attestation not verified. - Other: This category could include various statuses used by an Exchange. |
Alphanumeric | 1000 | "Successful manual verification", "Unsuccessful manual verification", "Other - Insufficient document. The consumer was asked to submit additional document(s) to confirm their attested information, and the inconsistency was not successfully resolved" |
| Inconsistency Sub-Type | A field that describes the sub type of inconsistency that was generated by the Exchange. | The Exchange may trigger several sub types of inconsistencies based on which consumer attestation(s) are found to be inconsistent with Trusted Data Sources. Inconsistency Subtype is associated with unique verification issue within the application. It further classifies the inconsistency type. This field may or may not be applicable for all Exchanges. |
Alphanumeric | 100 | "citizenship_born_qhp" |
| Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | N/A | Date | 9 | "12JAN2021" |
| Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | N/A | Alphanumeric | 100 | "12345678" |
| Insurance Policy Selected Date | Date when the insurance policy was selected. | N/A | Date | 9 | "12JAN2021" |
| Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | N/A | Date | 9 | "12JAN2021" |
| Insurance Policy Status | The status of the Policy which the applicants are enrolled in. | Possible values are: - Initial enrollment: An intent to enroll in a health plan. The policy has not been accepted by the issuer but the process to initiate that process has started - Effectuated: A policy has been created by the initial enrollment request, confirmed by the Issuer, and begun coverage as of the policy effective date. - Canceled: Policy has been cancelled. A policy can only be cancelled if coverage has not started, i.e., had not been effectuated. - Terminated: Coverage has ended for the policy after the policy was effectuated (providing coverage). |
Alphanumeric | 100 | "Initial enrollment" |
| IRS Annual Tax Household Income Amount | The Annual Tax Household Income amount returned from IRS. | N/A | Decimal | 10 | "60000" |
| IRS Income Data Available | Indicates whether or not Income verification data was found in the IRS. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| IRS Tax Form Receipt | Indicates whether the tax household anchor attested that the tax household reconciled to premium tax credits on last year's tax return. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Issuer Benefit End Date | Benefit end date for the QHP coverage period as reflected by Issuer records. | N/A | Date | 9 | "12JAN2021" |
| Issuer Benefit Start Date | Benefit start date for the QHP coverage period as reflected by Issuer records. | N/A | Date | 9 | "12JAN2021" |
| Issuer Effectuation Status | Indicates whether the applicant paid their initial premium for a given policy as indicated by issuer. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Issuer Policy Applied APTC Amount | The amount of APTC that has been applied to the policy as reflected by Issuer records. | N/A | Decimal | 10 | "2000" |
| Issuer Reconciliation Data Matching Issue Indicator For Applied APTC Amount | Indicates whether Issuer and Exchange had data matching issues during reconciliation for applied APTC amount. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Issuer Reconciliation Data Matching Issue Indicator For Benefit End Date | Indicates whether Issuer and Exchange had data matching issues during reconciliation for benefit end date. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Issuer Reconciliation Data Matching Issue Indicator For Benefit Start Date | Indicates whether Issuer and Exchange had data matching issues during reconciliation for benefit start date. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Issuer Reconciliation Data Matching Issue Indicator For Effectuation Status | Indicates whether the issuer and Exchange had data matching issues during reconciliation for effectuation status. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Issuer Reconciliation Data Matching Issue Resolution For Applied APTC Amount | Indicates the action taken to resolve data discrepancies between the issuer and Exchange for applied APTC amount. | N/A | Alphanumeric | 1000 | "Exchange keeps data value and tells issuer to update their data records", "Exchange adopts issuer data values" |
| Issuer Reconciliation Data Matching Issue Resolution For Benefit End Date | Indicates the action taken to resolve data discrepancies between the issuer and Exchange for benefit end date. | N/A | Alphanumeric | 1000 | "Exchange keeps data value and tells issuer to update their data records", "Exchange adopts issuer data values" |
| Issuer Reconciliation Data Matching Issue Resolution For Benefit Start Date | Indicates the action taken to resolve data discrepancies between the issuer and Exchange for benefit start date. | N/A | Alphanumeric | 1000 | "Exchange keeps data value and tells issuer to update their data records", "Exchange adopts issuer data values" |
| Issuer Reconciliation Data Matching Issue Resolution For Effectuation Status | Indicates the action taken to resolve data discrepancies between the issuer and Exchange for effectuation status. | N/A | Alphanumeric | 1000 | "Exchange keeps data value and tells issuer to update their data records", "Exchange adopts issuer data values" |
| Issuer Total Premium Amount | Issuer total premium amount provided during the reconciliation process. | N/A | Decimal | 10 | "2000" |
| Last Name | Last name of application member | N/A | Alphanumeric | 100 | "Brown" |
| Latest Policy Record | For a specific policy, if multiple versions exist, this indicator will represent the latest version for that policy. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Lawful Presence Inconsistency | The number of lawful presence verification inconsistencies that were associated to a tax household for a given plan year. Note: if SE cannot provide a specific count, then a "Y/N" value is acceptable to indicate that an inconsistency type exists for the tax household | N/A | Numeric | 3 | "1", "8", "Y", "N" |
| Lawful Presence Inconsistency Manual Adjudication Conducted | Indicates whether a Lawful Presence verification inconsistency was manually adjudicated. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Lawful Presence Verification Date | Date when verification of lawful presence attestation was conducted. | This date associates to each unique member on the application. | Date | 9 | "12JAN2021" |
| Lawful Presence Verification Reason | The findings used to set the final verification result in corroborating the consumer’s attestation. | Reasons for the verification result can vary depending on the verification logic used by the Exchange. For example, the reason could be ‘Inconsistent with External Data Source’ if the verification logic is simply using a basic comparison of the consumer’s attestation with those observed from the external data source. If the consumer does not exactly match the external data source, then the consumer receives a Verification Result of ‘Inconsistent’. | Alphanumeric | 1000 | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information", "Applicant attestation was over set thresholds" |
| Lawful Presence Verification Result | The final determination on whether the Exchange was able to verify the consumer’s attestation. | The verification result should clearly indicate if the verification was successful in verifying the attestation, or if inconsistency was found. | Alphanumeric | 100 | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" |
| Lived In Foreign Country 60 Days Before Marriage Indicator | Indicates whether the applicant or the spouse attested to living in a foreign country or U.S. territory within 60 days before the marriage. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Lived In No QHP Zone Within 60 Days Before Marriage Indicator | Indicates whether the applicant or the spouse attested to living in a service area where no QHP was available through the Exchange within 60 days before the marriage. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Lived In No QHP Zone Within 60 Days Before Move Indicator | Indicates whether the applicant attested to moving from a service area where no QHP was available through the Exchange within the last 60 days. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Lived in US 5 Years Indicator | Indicates whether an applicant attested to living in the US for at least 5 years. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Mailing City | Applicant mailing city. | N/A | Alphanumeric | 100 | "McLean" |
| Mailing State Code | Applicant mailing state code. | N/A | Alphanumeric | 10 | "VA" |
| Mailing Street Address | Applicant mailing street address. | N/A | Alphanumeric | 100 | "123 Forrest Street" |
| Mailing Zip Code | Applicant mailing zip code. | N/A | Alphanumeric | 10 | "22102" |
| Manual Income Verification Result | Outcome of income verification performed by manual reviewers to assess compatibility between attested and documented income. | The values for this field should clearly indicate if the manual income verification was successful or not. | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Maximum APTC Amount | The maximum advanced payment tax credit amount for which the tax household is eligible for. | N/A | Decimal | 10 | "2000" |
| Medicaid Denied Date | Date that an applicant was denied eligibility for Medicaid. | N/A | Date | 9 | "12JAN2021" |
| Medicaid Denied Indicator | Indicates whether an applicant has been denied eligibility for Medicaid in the last 60 days. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Medicaid/CHIP Confirmed Dual Enrollment | Medicaid CHIP was confirmed to be dually enrolled and applicant has not resolved issue within the allotted resolution period. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Medicaid/CHIP Confirmed Expiration Date | The date when applicant failed to resolve their Medicaid/CHIP dual enrollment issue within the allotted resolution period. | N/A | Date | 9 | "12JAN2021" |
| Medicaid/CHIP PDM Actual Run Date | Date when Medicaid/CHIP PDM was executed for application member. | N/A | Date | 9 | "12JAN2021" |
| Medicaid/CHIP PDM Scheduled Date | The date during the benefit year when the Medicaid/CHIP PDM is scheduled to occur. | There should be at least two dates scheduled for Medicaid/CHIP PDM. | Date | 9 | "12JAN2021" |
| Medicare Dual Enrollment Status | Indicates whether an applicant is dually enrolled in Medicare and Non ESC MEC. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Medicare PDM Actual Run Date | Date when Medicare PDM was executed for application member. | N/A | Date | 9 | "12JAN2021" |
| Medicare PDM Scheduled Date | The date during the benefit year when the Medicare PDM is scheduled to occur. | There should be at least two dates scheduled for Medicare PDM. | Date | 9 | "12JAN2021" |
| Medicare Resolution Status | Status used to indicate whether or not an applicant has resolved Medicare dual-enrollment issues with application. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Member Association Role Type | The relationship the member has to the tax filer. | N/A | Alphanumeric | 10 | "spouse", "daughter", "son" |
| Member-Level Allocated APTC Amount | Allocated APTC Amount is the amount that is allocated to the policy based on the amount the tax household has elected without consideration for amounts that are reallocated from other policies. The final amount of APTC that is applied takes into consideration the amounts that are leftover from policies. | This is a numeric text value. | Decimal | 10 | "2000" |
| Middle Name | Middle name of application member | N/A | Alphanumeric | 100 | "David" |
| Moved From Foreign Country Within Last 60 Days Indicator | Indicates whether the applicant attested to moving from a foreign country to the USA within the last 60 days. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Multiple Tax Household Indicator | Indicates whether the insurance application contains multiple tax households. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| No IRS Data For Past 3 Benefit Years | Indicates whether the Exchange has not received updated IRS data for the application member within the past three years. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| No Updates to Application For Past 2 Benefit Years | Indicates whether an application member has not updated their application within the past two benefit years. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Non-ESC MEC Coverage End Date | The date that the applicants Non-ESC MEC coverage ended or will end. | N/A | Date | 9 | "12JAN2021" |
| Non-ESC MEC EDS Data Found | Hub returned data for any Non-ESC MEC coverage | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Non-ESC MEC Inconsistency | The number of Non-ESC MEC verification inconsistencies that were associated to a tax household for a given plan year. Note: if SE cannot provide a specific count, then a "Y/N" value is acceptable to indicate that an inconsistency type exists for the tax household | N/A | Numeric | 3 | "1", "8", "Y", "N" |
| Non-ESC MEC Inconsistency Identifier | A unique identifier for an inconsistency generated as a result of unsuccessful electronic verifications of Non-ESC MEC coverage performed by the Exchange. | An inconsistency is triggered by the Exchange when the outcome of a verification indicates a discrepancy between the applicant's attestation and the information available from a Trusted Data Source. An inconsistency identifier would be assigned for each event where an inconsistency is triggered by the Exchange. The inconsistency identifier would be specific to each type of inconsistency triggered by the Exchange pertaining to any application member. In the event that an Exchange does not have dedicated inconsistency identifiers to identify unique inconsistencies, the Exchange could create such an identifier as long as it is unique within the sample. |
Alphanumeric | 10 | "123456789" |
| Non-ESC MEC Inconsistency Manual Adjudication Conducted | Indicates whether a Non-ESC MEC verification inconsistency was manually adjudicated. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Non-ESC MEC Verification Determination Date | The date that the application Non-ESC MEC verification was determined. | N/A | Date | 9 | "12JAN2021" |
| Non-ESC MEC Verification Reason | The findings used to set the final verification result in corroborating the consumer’s attestation. | Reasons for the verification result can vary depending on the verification logic used by the Exchange. For example, the reason could be ‘Inconsistent with External Data Source’ if the verification logic is simply using a basic comparison of the consumer’s attestation with those observed from the external data source. If the consumer does not exactly match the external data source, then the consumer receives a Verification Result of ‘Inconsistent’. | Alphanumeric | 1000 | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information", "Applicant attestation was over set thresholds" |
| Non-ESC MEC Verification Result | Indicator denoting the verification result of a Non-ESC MEC verification. | N/A | Alphanumeric | 100 | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" |
| Number of Tax Household Members | Total number of individuals considered to be part of a tax household | N/A | Integer | 10 | "1" |
| Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | N/A | Alphanumeric | 10 | "12345678" |
| Physical Document Type | The type of document that would be supplied by the consumer to validate or verify certain eligibility status (e.g. citizenship, lawful presence). Specific physical document types would require manual adjudication. | N/A | Alphanumeric | 100 | |
| Plan Certified Indicator | Indicates whether the selected QHP by the consumer has been certified | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Plan Year | Year for which this plan has been created. | N/A | Integer | 10 | "2021", "2022", "2023" |
| Policy Applied APTC Amount | The amount of APTC that has been applied to the policy. | N/A | Decimal | 10 | "2000" |
| Policy Creation Date | The date when the policy was created. | N/A | Date | 9 | "12JAN2021" |
| QHP Eligibility Determination Date | Date when the application member's QHP eligibility was determined. | N/A | Date | 9 | "12JAN2021" |
| QHP Eligibility Indicator | Indicates if the Exchange determines an applicant is eligible for QHP. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| QHP Eligibility Reason | Reason for the given determination for QHP eligibility. | N/A | Alphanumeric | 100 | "Applicant is incarcerated", "Applicant is neither a citizen or has lawful presence", "Applicant meets all QHP eligibility criteria" |
| QHP Residency Eligibility Determination Date | Date when the application member QHP Residency date was determined. | N/A | Date | 9 | "12JAN2021" |
| QHP Residency Eligibility Indicator | Indicates whether the applicant was determined to be QHP Residency eligible. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| QHP Residency Eligibility Reason | Reason for the given determination for QHP Residency eligibility. | N/A | Alphanumeric | 100 | "Applicant residency is out of state" |
| QHP Suppression Date | Date of QHP suppression. | N/A | Date | 9 | "12JAN2021" |
| QHP Suppression Reason | Reason for the suppression of a QHP. | N/A | Alphanumeric | 100 | "Exchange freezes new enrollments" |
| QHP Unsuppression Date | Date of QHP unsuppression. | N/A | Date | 9 | "12JAN2021" |
| Relevant Consumer Documents | A list of documents provided by the consumer to adjudicate a specific inconsistency, including name, date received, and any other relevant information. If providing multiple documents, please separate document by semi-colon |
Not all documents from the consumer may be used to adjudicate an inconsistency. | Alphanumeric | 1000 | "I-551 Card (Received on 01-01-2020) via Mailroom" |
| Residency Inconsistency Manual Adjudication Conducted | Indicates whether a Residency verification inconsistency was manually adjudicated. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Residency Verification Date | Date when verification of residency attestation was conducted. | This date associates to each unique member on the application. | Date | 9 | "12JAN2021" |
| Residency Verification Reason | The findings used to set the final verification result in corroborating the consumer’s attestation. | Reasons for the verification result can vary depending on the verification logic used by the Exchange. For example, the reason could be ‘Inconsistent with External Data Source’ if the verification logic is simply using a basic comparison of the consumer’s attestation with those observed from the external data source. If the consumer is not found within the external data source, then the consumer's attestation value is used. | Alphanumeric | 1000 | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information" |
| Residency Verification Result | The final determination on whether the Exchange was able to verify the consumer’s attestation. | The verification result should clearly indicate if the verification was successful in verifying the attestation, or if inconsistency was found. | Alphanumeric | 100 | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" |
| Second Lowest Cost Silver Plan Premium Amount | This is the essential health benefits EHB adjusted monthly premium of the Second Lowest Cost Silver Plan (SLCSP) (or sum of SLCSPs) that cover the primary taxpayer, his or her spouse, and their tax dependents for use in computing max advance payments of the premium tax credit. | N/A | Decimal | 10 | "2000" |
| Selected For Sample (Filled Out By SBE) | Indicator that flags whether a tax household was selected as part of the sample for review | N/A | Alphanumeric | 3 | "Yes", "No" |
| Selected Insurance Plan Identifier | Insurance plan identifier for the policy selected by the applicant. | This indicator is made of a code, 2 sets of numbers identifying the plan selected, with the state abbreviation in between them. | Alphanumeric | 100 | "99969OH100010" |
| SEP Eligibility Determination Date | The date when the application members SEP eligibility was determined. | N/A | Date | 9 | "12JAN2021" |
| SEP Eligibility End Date | The date that the application SEP eligibility ended or will end. | N/A | Date | 8 | "12JAN2021" |
| SEP Eligibility Indicator | Indicator that marks which SEP the application is eligible for based on the applicant's attestation. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| SEP Eligibility Start Date | The date that the application SEP eligibility started or will start. | N/A | Date | 9 | "12JAN2021" |
| SEP Manual Adjudication Clock End Date | Date when the SEP manual adjudication ends. | N/A | Date | 9 | "12JAN2021" |
| SEP Manual Adjudication Date | Date when the SEP was manually adjudicated. | N/A | Date | 9 | "12JAN2021" |
| SEP Manual Adjudication Identifier | A unique identifier for a SEP manual review performed by the Exchange. | N/A | Alphanumeric | 10 | "123456789" |
| SEP Manual Adjudication Indicator | Indicates if the SEP application was manually adjudicated by the exchange. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| SEP Manual Adjudication Status | Outcome of the manual SEP verification adjudication. | N/A | Alphanumeric | 100 | "Expired", "Obsolete", "Resolved", "Running" |
| SEP Type | The type of SEP. | N/A | Alphanumeric | 100 | "Adoption", "Newborn", "Marriage", "Relocation", "Loss of MEC" |
| Special Rule For Non-Citizens Override Indicator | Indicates whether an applicant who is lawfully present, with income below the 100% FPL, but is ineligible for Medicaid by reason of immigration status, making them eligible for APTC. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| SSN Inconsistency | The number of SSN inconsistencies that were associated to a tax household for a given plan year. Note: if SE cannot provide a specific count, then a "Y/N" value is acceptable to indicate that an inconsistency type exists for the tax household | N/A | Numeric | 3 | "1", "8", "Y", "N" |
| SSN Inconsistency Manual Adjudication Conducted | Indicates whether a SSN verification inconsistency was manually adjudicated. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| SSN Provided by Applicant | Social Security Number provided by applicant. | This field is only used for applicants who attest to citizenship, applicants who are lawfully present may or may not have an SSN. | Alphanumeric | 100 | "123-45-6789" |
| SSN Verification Date | Date when SSN attestation verification was conducted. | This date associates to each unique member on the application. | Date | 9 | "12JAN2021" |
| SSN Verification Reason | The findings used to set the final verification result in corroborating the consumer’s attestation. | Reasons for the verification result can vary depending on the verification logic used by the Exchange. For example, the reason could be ‘Inconsistent with External Data Source’ if the verification logic is simply using a basic comparison of the consumer’s attestation with those observed from the external data source. If the consumer does not exactly match the external data source, then the consumer receives a Verification Result of ‘Inconsistent’. |
Alphanumeric | 1000 | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information", "Applicant attestation was over set thresholds" |
| SSN Verification Result | The final determination on whether the Exchange was able to verify the consumer’s attestation. | The verification result should clearly indicate if the verification was successful in verifying the attestation, or if inconsistency was found. |
Alphanumeric | 100 | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" |
| Tax Dependent Indicator | Applicant attesting to being a dependent within a tax household. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Tax Filer Indicator | Applicant attesting to being a tax filer within a tax household. | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| Tax Filing Status | Tax filing status of an applicant. | N/A | Alphanumeric | 100 | "Single", "Married", "Married Filing Separately" |
| Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | N/A | Alphanumeric | 10 | "0123456789" |
| Tax Household Size in Manual Income Verification | Tax household size reflected any standard or custom tool / method / process for manual verification. | This may not be applicable to Exchanges. |
Integer | 10 | "2" |
| Transient City | Applicant intended future home city. | N/A | Alphanumeric | 100 | "McLean" |
| Transient State Code | Applicant intended future home state code. | N/A | Alphanumeric | 10 | "VA" |
| Transient Street Address | Applicant intended future home street address. | N/A | Alphanumeric | 100 | "123 Forrest Street" |
| Transient Zip Code | Applicant intended future mailing zip code. | N/A | Alphanumeric | 10 | "22102" |
| Attested Premium Amount | Consumer attested ESC MEC Premium amount. | N/A | Decimal | 10 | "60000" |
| Employer Verified Premium Amount | ESC MEC Premium amount as stated by employer during sampling. | N/A | Decimal | 11 | "60000" |
| As-Of Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | date/timestamp | 16 | yyyy-mm-dd-hh. mm. | |
| Received APTC Prior Year | Indicates that an application member has received APTC the previous year | N/A | Alphanumeric | 10 | "True", "False", "Yes", "No", "Y", "N" |
| SEP Inconsistency Identifier | A unique identifier for an inconsistency generated as a result of unsuccessful electronic verifications of SEP coverage performed by the Exchange. | An inconsistency is triggered by the Exchange when the outcome of a verification indicates a discrepancy between the applicant's attestation and the information available from a Trusted Data Source. An inconsistency identifier would be assigned for each event where an inconsistency is triggered by the Exchange. The inconsistency identifier would be specific to each type of inconsistency triggered by the Exchange pertaining to any application member. In the event that an Exchange does not have dedicated inconsistency identifiers to identify unique inconsistencies, the Exchange could create such an identifier as long as it is unique within the sample. |
Alphanumeric | 10 | "123456789" |
| SEP Auto-Verification Inconsistency Result | Indicator denoting the verification result of a SEP Auto-Verification. | N/A | Alphanumeric | 100 | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" |
| Incarceration Inconsistency | A unique identifier for an inconsistency generated as a result of an incarceration inconsistency by the Exchange. | An inconsistency is triggered by the Exchange when the outcome of a verification indicates a discrepancy between the applicant's attestation and the information available from a Trusted Data Source. An inconsistency identifier would be assigned for each event where an inconsistency is triggered by the Exchange. The inconsistency identifier would be specific to each type of inconsistency triggered by the Exchange pertaining to any application member. In the event that an Exchange does not have dedicated inconsistency identifiers to identify unique inconsistencies, the Exchange could create such an identifier as long as it is unique within the sample. |
Alphanumeric | 10 | "123456789" |
| Residency Inconsistency | A unique identifier for an inconsistency generated as a result of an residency inconsistency by the Exchange. | An inconsistency is triggered by the Exchange when the outcome of a verification indicates a discrepancy between the applicant's attestation and the information available from a Trusted Data Source. An inconsistency identifier would be assigned for each event where an inconsistency is triggered by the Exchange. The inconsistency identifier would be specific to each type of inconsistency triggered by the Exchange pertaining to any application member. In the event that an Exchange does not have dedicated inconsistency identifiers to identify unique inconsistencies, the Exchange could create such an identifier as long as it is unique within the sample. |
Alphanumeric | 10 | "123456789" |
| Legend | |||||||||||
| Disclaimer: SBEs should review this sheet in chronological order from top to bottom. | |||||||||||
| Cell Color | Cell Format | Description | |||||||||
| Underlined | Indicates new data element RC is requesting from SBE. The RC requests the SBE to provide data mapping element associated with the information element. If the state does not have the data mapping element, please indicate so under column "F" and any alternative to achieve data mapping under column "G". | ||||||||||
| No Underline | Indicates data element associated with review unit in which the RC is not requesting data mapping for since this information was peviously requested. The SBE does NOT need to input information in these cells. | ||||||||||
| Data Mapping by State | |||||||||||
| Data Mapping | Information Element | Information Element Definition | Example | Does the State Have Data Element to Test Review Unit? | If NOT, alternative data element provided by SBE to meet the data requirement. | Note | |||||
| 4. Review Area: Electronic Verification of Applications | |||||||||||
| 4.1 Review Module: Confirm SSN Electronic Verification | |||||||||||
| • 4.1.1 Review Unit: Confirm SSN Verification was Conducted - Determine whether SSN electronic verification was conducted when an SSN is provided. | |||||||||||
| Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | "0123456789" | |||||||||
| Application Identifier | A unique identifier for an application household (or households) during a given Plan / Benefit Year. | "A123456", "12345678", "A1-2024-MD" -- (an example of a generated Application Identifier for the Plan Year 2024 review for the state of MD) | |||||||||
| Application Version | A sequence number that is used to distinguish various events for an application, i.e. the creation and subsequent changes or updates made to an application during a Plan / Benefit Year. | "1", "2", "01/22/2020" | |||||||||
| Application Submission Date | A field that is used to reflect the date that an application was submitted. | "12JAN2021" | |||||||||
| Person Tracking Number | A unique identification number that is used to identify a person. | "12345678" | |||||||||
| As-Of-Date | A date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | "yyyy-mm-dd-hh. mm." | |||||||||
| SSN Provided by Applicant | Social Security Number provided by applicant | "123-45-6789" | |||||||||
| First Name | First name of application member. | "Sherwin" | |||||||||
| Middle Name | Middle name of application member. | "David" | |||||||||
| Last Name | Last Name of application member. | "Brown" | |||||||||
| Birth Date | Birth Date of an application member. | "12JAN2021" | |||||||||
| Application Creation Date | A field that is used to reflect the date that an application was created prior to being submitted. | "12JAN2021" | |||||||||
| Application Event Type | The different types of events that led to the creation or change, update to an application. | "Initial Application" | |||||||||
| Application Event Source | The origin event that led to the creation or change, update to an application. | "Consumer online submission" | |||||||||
| Attested Coverage Request | An indicator that the application member attested to applying for coverage. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| SSN Verification Date | Date when SSN attestation verification was conducted. | "12JAN2021" | |||||||||
| SSN Verification Result | The final determination on whether the Exchange was able to verify the consumers attestation. | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" | |||||||||
| SSN Verification Reason | The findings used to set the final verification result in corroborating the consumer's attestation. | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information", "Applicant attestation was over set thresholds" | |||||||||
| • 4.1.2 Review Unit: Confirm SSN Verification was Concluded Properly - Determine whether SSN electronic verification was concluded properly, and an inconsistency was initiated when appropriate. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | SSN Provided by Applicant | Social Security Number provided by applicant | |||||||||
| 0 | First Name | First name of application member. | |||||||||
| 0 | Middle Name | Middle name of application member. | |||||||||
| 0 | Last Name | Last name of application member. | |||||||||
| 0 | Birth Date | Birth Date of an application member. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | SSN Verification Date | Date when SSN attestation verification was conducted. | |||||||||
| 0 | SSN Verification Result | The final determination on whether the Exchange was able to verify the consumers attestation. | |||||||||
| 0 | SSN Verification Reason | The findings used to set the final verification result in corroborating the consumer's attestation. | |||||||||
| SSN Inconsistency Manual Adjudication Conducted | Indicates whether an SSN verification inconsistency was manually adjudicated | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Citizenship Verification Result | The final determination on whether the Exchange was able to verify the consumer’s attestation. | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" | |||||||||
| Citizenship Verification Reason | The findings used to set the final verification result in corroborating the consumer’s attestation. | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information", "Applicant attestation was over set thresholds" | |||||||||
| Citizenship Inconsistency Manual Adjudication Conducted | Indicates whether a Citizenship verification inconsistency was manually adjudicated. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Death Data Present | SSA indicated that applicant is associated with death data. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| • 4.1.3 Review Unit: Confirm Single Use of SSN - Determine if multiple individuals incorrectly used the same SSN. Note that an individual is defined here by a unique combination of first name, last name, birth date, and Application Member ID. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | SSN Provided by Applicant | Social Security Number provided by applicant | |||||||||
| 0 | First Name | First name of application member. | |||||||||
| 0 | Middle Name | Middle name of application member. | |||||||||
| 0 | Last Name | Last name of application member. | |||||||||
| 0 | Birth Date | Birth Date of an application member. | |||||||||
| 4.2 Review Module: Confirm Citizenship/LP Electronic Verification | |||||||||||
| • 4.2.1 Review Unit: Confirm Citizenship/LP Verification was Conducted - Determine if the Exchange conducted citizenship / LP verification when applicants (refer to the Glossary for definition) attested to having citizenship or LP. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | First Name | First name of application member. | |||||||||
| 0 | Middle Name | Middle name of application member. | |||||||||
| 0 | Last Name | Last name of application member. | |||||||||
| 0 | Birth Date | Birth Date of an application member. | |||||||||
| 0 | Application Creation Date | A field that is used to reflect the date that an application was created prior to being submitted. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Attested Citizenship Status Indicator | Indicates whether applicant attests he/she is a US citizen. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Attested Lawfully Present Status Indicator | Indicates whether an applicant attests to being lawfully present. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Citizenship Verification Date | Date when verification of citizenship attestation was conducted. | "12JAN2021" | |||||||||
| Lawful Presence Verification Date | Date when verification of lawful presence attestation was conducted. | "12JAN2021" | |||||||||
| • 4.2.2 Review Unit: Confirm Citizenship/LP Verification was Concluded Properly - Determine whether citizenship / LP verification was concluded properly, and an Inconsistency was initiated when appropriate. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan / Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e. the creation and subsequent changes or updates made to an application during a Plan / Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person. | |||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | SSN Provided by Applicant | Social Security Number provided by applicant | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Attested Citizenship Status Indicator | Indicates whether application member attests he/she is a US citizen. | |||||||||
| 0 | Attested Lawfully Present Status Indicator | Indicates whether an application member attests to being lawfully present. | |||||||||
| 0 | Citizenship Verification Date | Date when verification of citizenship attestation was conducted. | |||||||||
| Citizenship Verification Result | The final determination on whether the Exchange was able to verify the consumer’s attestation. | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" | |||||||||
| 0 | Citizenship Verification Reason | The findings used to set the final verification result in corroborating the consumer’s attestation. | |||||||||
| Physical Document Type | The type of document that would be supplied by the consumer to validate or verify certain eligibility status (e.g. citizenship, lawful presence). Specific physical document types would require manual adjudication. | "Passport" | |||||||||
| 0 | Citizenship Inconsistency Manual Adjudication Conducted | Indicates whether a Citizenship verification inconsistency was manually adjudicated. | |||||||||
| 0 | Lawful Presence Verification Date | Date when verification of lawful presence attestation was conducted. | |||||||||
| Lawful Presence Verification Result | The final determination on whether the Exchange was able to verify the consumer’s attestation. | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" | |||||||||
| Immigration Status Expiration Date | Date when consumer's immigration status expires and needs to be redetermined. | "12JAN2021" | |||||||||
| Lawful Presence Verification Reason | The findings used to set the final verification result in corroborating the consumer’s attestation. | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information", "Applicant attestation was over set thresholds" | |||||||||
| Lawful Presence Inconsistency Manual Adjudication Conducted | Indicates whether a Lawful Presence verification inconsistency was manually adjudicated. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| • 4.2.3 Review Unit: Confirm Action on Immigration Status Redetermination - Identify situations where an application member’s coverage should have been terminated on their immigration status redetermination date (since no action is taken by the Exchange). | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan / Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e. the creation and subsequent changes or updates made to an application during a Plan / Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person. | |||||||||
| Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | "12JAN2021" | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Attested Lawfully Present Status Indicator | Indicates whether an application member attests to being lawfully present. | |||||||||
| 0 | Immigration Status Expiration Date | Date when consumer's immigration status expires and needs to be redetermined. | |||||||||
| 0 | RC Determined Result | An RC determined field indicating the result of an RU. | |||||||||
| 4.3 Review Module: Confirm Annual Household Income and Tax Household Size Verification | |||||||||||
| • 4.3.1 Review Unit: Confirm Income Verification Conducted - Confirm that annual household income verification was conducted for the application version. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan / Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e. the creation and subsequent changes or updates made to an application during a Plan / Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Application Creation Date | A field that is used to reflect the date that an application was created prior to being submitted. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| FPL Percentage Per Attested Income | Income as a percentage of the Federal Poverty Level (FPL) amount, calculated per advanced payment tax credit rules published by the treasury based on information provided by the consumer. | "60000" | |||||||||
| Income Verification Date | Date when verification of income attestation was conducted. | "12JAN2021" | |||||||||
| Income Verification Reason | The findings used to set the final verification result in corroborating the consumer’s attestation. | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information", "Applicant attestation was over set thresholds" | |||||||||
| • 4.3.2 Review Unit: Confirm Income Verification Concluded Properly - Determine whether income verification was concluded properly and an Inconsistency was initiated when appropriate. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan / Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e. the creation and subsequent changes or updates made to an application during a Plan / Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Attested Annual Household Income | The amount of annual income an application member attested to on the application. | "60000" | |||||||||
| 0 | Income Verification Date | Date when verification of income attestation was conducted. | |||||||||
| Income Verification Result | Indicator denoting the verification result of an income verification. | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" | |||||||||
| 0 | Income Verification Reason | The findings used to set the final verification result in corroborating the consumer’s attestation. | |||||||||
| Consumer Income Documented Amount | The amount of total annual tax income of the tax household calculated by the inconsistency verification worker based on documentation the application member provided. | "60000" | |||||||||
| Income Inconsistency Manual Adjudication Conducted | Indicates whether an Income verification inconsistency was manually adjudicated. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Consumer Income Document Effective End Date | The effective end date of the income document as submitted by the consumer. | "12JAN2021" | |||||||||
| APTC Eligibility Indicator | Indicates if member is eligible for APTC. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| • 4.3.3 Review Unit: Confirm Tax Household Size was Calculated Properly - Determine whether the tax household size is equal to the sum of all application members that were identified as part of the current year tax household. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan / Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e. the creation and subsequent changes or updates made to an application during a Plan / Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person. | |||||||||
| Member Association Role Type | The relationship the member has to the tax filer. | "spouse", "daughter", "son" | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Attested Tax Household Size | Attested number of individuals in the application related to tax filer members. | "2" | |||||||||
| • 4.3.4 Review Unit: Confirm Individuals are Present in Only One Application - For each distinct individual in the system, determine whether the individual is present on multiple applications receiving APTC payments during the same coverage month(s). A distinct individual corresponds to a distinct combination of first name, last name, SSN, and date of birth. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | "12345678" | |||||||||
| Policy Creation Date | The date when the policy was created. | "12JAN2021" | |||||||||
| Insurance Policy Status | The status of the Policy which the applicants are enrolled in. | "Initial enrollment" | |||||||||
| Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | "12JAN2021" | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| Policy Applied APTC Amount | The amount of APTC that has been applied to the policy. | "2000" | |||||||||
| 0 | SSN Provided by Applicant | Social Security Number provided by applicant | |||||||||
| 0 | First Name | First name of application member. | |||||||||
| 0 | Middle Name | Middle name of application member. | |||||||||
| 0 | Last Name | Last name of application member. | |||||||||
| 0 | Birth Date | Birth Date of an application member. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Attested Tax Household Size | Attested number of individuals in the application related to tax filer members. | |||||||||
| Member-Level Allocated APTC Amount | Allocated APTC Amount is the amount that is allocated to the policy based on the amount the tax household has elected without consideration for amounts that are reallocated from other policies. The final amount of APTC that is applied takes into consideration the amounts that are left over from policies. | "2000" | |||||||||
| Maximum APTC Amount | The maximum advanced payment tax credit amount for which the tax household is eligible for. | "2000" | |||||||||
| 4.4 Review Module: Confirm Residency Electronic Verification | |||||||||||
| • 4.4.1 Review Unit: Confirm Residency Verification was Conducted - Determine whether Residency electronic verification was conducted when an address is provided. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| Home Street Address | |||||||||||
| Home City | |||||||||||
| Home State Code | |||||||||||
| Home Zip Code | |||||||||||
| 0 | Application Creation Date | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| Residency Verification Date | Date when verification of residency attestation was conducted. | "12JAN2021" | |||||||||
| • 4.4.2 Review Unit: Confirm Residency Verification was Conducted Properly - Determine whether Residency electronic verification was concluded properly, and an inconsistency was initiated when appropriate. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | Home Street Address | ||||||||||
| 0 | Home City | ||||||||||
| 0 | Home State Code | ||||||||||
| 0 | Home Zip Code | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | Residency Verification Date | ||||||||||
| Residency Verification Result | The final determination on whether the Exchange was able to verify the consumer’s attestation. | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" | |||||||||
| Residency Verification Reason | The findings used to set the final verification result in corroborating the consumer’s attestation. | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information" | |||||||||
| 4.5 Review Module: Confirm Incarceration Electronic Verification | |||||||||||
| • 4.5.1 Review Unit: Confirm Incarceration Verification was Conducted - Determine whether Incarceration electronic verification was conducted when an Incarceration Attestation is provided. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Application Creation Date | A field that is used to reflect the date that an application was created prior to being submitted. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Attested Incarceration Status Indicator | Indicates whether an application member is incarcerated. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| • 4.5.2 Review Unit: Confirm Incarceration Verification was Concluded Properly - Determine whether Incarceration electronic verification was concluded properly, and an inconsistency was initiated when appropriate. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Attested Incarceration Status Indicator | Indicates whether an application member is incarcerated. | |||||||||
| Incarceration Verification Date | Date to which Incarceration Verification was conducted. | "12JAN2021" | |||||||||
| 4.6 Review Module: Confirm ESC MEC Verification | |||||||||||
| • 4.6.1 Review Unit: Confirm ESC MEC Verification was Conducted - Verify attestations of Employer Sponsored Coverage (ESC) Minimum Essential Coverage (MEC) to use in eligibility determinations. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Application Creation Date | A field that is used to reflect the date that an application was created prior to being submitted. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Attested ESC Offer | Indicates whether an applicant is eligible for Employer Sponsored health coverage. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Eligible for ESC Sampling | The application member is eligible to be added to the ESC sampling frame. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Chosen for ESC Sampling | Application member was selected as a part of the statistically significant subset and will be verified via the sampling process. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| ESC Data Source | The external data source that is used to verify the ESC attestation. | "Office of Personnel Management", "Employer Sampled Information" | |||||||||
| ESC Data Found | Indicates whether or not ESC verification data was found in the data source. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| ESC Meets MEC and Affordability Standards-based on attested premium amount | Indicates whether consumers ESC meets Minimum Essential Coverage (MEC) and Affordability standards based on consumer attested premium amount. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| ESC Meets MEC and Affordability Standards-based on employer verified premium amount | Indicates whether consumers ESC meets Minimum Essential Coverage (MEC) and Affordability standards based on employer verified premium amount. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| ESC Verification Determination Date-Attested | Date when verification of ESC MEC attestation was conducted. | "12JAN2021" | |||||||||
| ESC Verification Determination Date-Employer Verified | Date when Employer ESC MEC verification was conducted. | "12JAN2021" | |||||||||
| ESC Verification Result-Attested | Indicator denoting the verification result of attested ESC MEC. | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found", "Hold" | |||||||||
| ESC Verification Result-Employer Verified | Indicator denoting the verification result of employer stated ESC coverage. | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found", "Hold" | |||||||||
| APTC Eligibility Date | Date when the APTC eligibility was determined for an application member. | "12JAN2021" | |||||||||
| 0 | APTC Eligibility Indicator | Indicates if member is eligible for APTC. | |||||||||
| • 4.6.2 Review Unit: Confirm ESC MEC Verification was Concluded Properly - Verify attestations of Employer Sponsored Coverage (ESC) Minimum Essential Coverage (MEC) to use in eligibility determinations was conducted properly. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Attested ESC Offer | Indicates whether an applicant is eligible for Employer Sponsored health coverage. | |||||||||
| Attested Premium Amount | Consumer attested ESC MEC Premium amount. | "1,000" | |||||||||
| 0 | ESC Data Source | The external data source that is used to verify the ESC attestation. | |||||||||
| 0 | ESC Data Found | Indicates whether or not ESC verification data was found in the data source. | |||||||||
| ESC Inconsistency Manual Adjudication Conducted | Indicates whether an ESC verification inconsistency was manually adjudicated. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | ESC Meets MEC and Affordability Standards-based on attested premium amount | Indicates whether consumers ESC meets Minimum Essential Coverage (MEC) and Affordability standards based on consumer attested premium amount. | |||||||||
| 0 | ESC Meets MEC and Affordability Standards-based on employer verified premium amount | Indicates whether consumers ESC meets Minimum Essential Coverage (MEC) and Affordability standards based on employer verified premium amount. | |||||||||
| 0 | ESC Verification Determination Date-Attested | Date when verification of ESC MEC attestation was conducted. | |||||||||
| 0 | ESC Verification Determination Date-Employer Verified | Date when Employer ESC MEC verification was conducted. | |||||||||
| 0 | ESC Verification Result-Attested | Indicator denoting the verification result of attested ESC MEC. | |||||||||
| 0 | ESC Verification Result-Employer Verified | Indicator denoting the verification result of employer stated ESC coverage. | |||||||||
| 4.7 Review Module: Confirm Non ESC MEC Verification | |||||||||||
| • 4.7.1 Review Unit: Confirm Non ESC MEC Verification was Conducted - Confirm that Non-ESC MEC verification was conducted for each application version prior to being used in eligibility determinations. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Application Creation Date | A field that is used to reflect the date that an application was created prior to being submitted. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Attested Non-ESC MEC Offer | Indicates whether the applicant attests to being enrolled in non-employer sponsored health coverage. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Non-ESC MEC Verification Determination Date | The date that the application Non-ESC MEC verification was determined. | "12JAN2021" | |||||||||
| Non-ESC MEC Verification Result | Indicator denoting the verification result of a Non-ESC MEC verification. | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" | |||||||||
| Non-ESC MEC Verification Reason | The findings used to set the final verification result in corroborating the consumer's attestation. | "External data source not reasonably compatible with attestation", "Applicant did not give sufficient information", "Applicant attestation was over set thresholds" | |||||||||
| QHP Eligibility Indicator | Indicates if the Exchange determines an applicant is eligible for QHP. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| • 4.7.2 Review Unit: Confirm Non ESC MEC Verification was Concluded Properly - Confirm whether an application member’s attestations of coverage through a public Non-ESC MEC plan was verified against approved external data source and an inconsistency was raised when appropriate. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Attested Non-ESC MEC Offer | Indicates whether the applicant attests to being enrolled in non-employer sponsored health coverage. | |||||||||
| Medicaid Denied Date | Date that an applicant was denied eligibility for Medicaid. | "12JAN2021" | |||||||||
| 0 | Non-ESC MEC Verification Determination Date | The date that the application Non-ESC MEC verification was determined. | |||||||||
| Non-ESC MEC EDS Data Found | Hub returned data for any Non-ESC MEC coverage. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | Non-ESC MEC Verification Result | Indicator denoting the verification result of a Non-ESC MEC verification. | |||||||||
| 0 | Non-ESC MEC Verification Reason | The findings used to set the final verification result in corroborating the consumer's attestation. | |||||||||
| Non-ESC MEC Inconsistency Identifier | A unique identifier for an inconsistency generated as a result of unsuccessful electronic verifications of Non-ESC MEC coverage performed by the Exchange. | "123456789" | |||||||||
| Non-ESC MEC Inconsistency Manual Adjudication Conducted | Indicates whether a Non-ESC MEC verification inconsistency was manually adjudicated. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | QHP Eligibility Indicator | Indicates if the Exchange determines an applicant is eligible for QHP. | |||||||||
| 5. Review Area: Inconsistency Adjudication and Conclusion | |||||||||||
| 5.1 Review Module: General Inconsistency Review | |||||||||||
| • 5.1.1 Review Unit: Verify Inconsistency Document Submission Timeline - Verify the consumer provided documents within the regulatory timeframe for inconsistency resolution. | |||||||||||
| Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | "0123456789" | |||||||||
| Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | "A123456", "12345678", "A1-2024-MD" -- (an example of a generated Application Identifier for the Plan Year 2024 review for the state of MD) | |||||||||
| Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | "1", "2", "01/22/2020" | |||||||||
| Application Submission Date | A field that is used to reflect the date that an application was submitted. | "12JAN2021" | |||||||||
| Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | "12345678" | |||||||||
| As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | "yyyy-mm-dd-hh. mm." | |||||||||
| 0 | First Name | First name of application member. | |||||||||
| 0 | Middle Name | Middle name of application member. | |||||||||
| 0 | Last Name | Last name of application member. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Inconsistency Identifier | A unique identifier for an inconsistency generated as a result of unsuccessful electronic verifications performed by the Exchange. | "123456789" | |||||||||
| Inconsistency Sub-Type | A field that describes the sub type of inconsistency that was generated by the Exchange. | "citizenship_born_qhp" | |||||||||
| Inconsistency Status | An indicator that reflects the current status. | "Successful manual verification", "Unsuccessful manual verification", "Other - Insufficient document. The consumer was asked to submit additional document(s) to confirm their attested information, and the inconsistency was not successfully resolved" | |||||||||
| Adjudication History | A description of the history of adjudicating an inconsistency. | "This inconsistency was resolved on 01-01-2020 using an I-551 card. DHS SAVE was not used." | |||||||||
| Relevant Consumer Documents | A list of documents provided by the consumer to adjudicate a specific inconsistency, including name, date received, and any other relevant information. | "I-551 Card (Received on 01-01-2020) via Mailroom" | |||||||||
| All Consumer Documents | A list of all consumer documents received by the Exchange associated to the members of an application, including the type(s) of documents received, the date(s) the documents were received and the mode they were received. | "I-551 Card (Received on 01-01-2020) via Mailroom, Passport (Received on 02-01-2020) uploaded to web site, 1040 (Received on 03-01-2020) via Mailroom" | |||||||||
| Inconsistency Clock End Date | The clock end date set by the Exchange based on the date the inconsistency was triggered. | "12JAN2021" | |||||||||
| Inconsistency Clock End Date (Alternative) | The clock end date set by the Exchange based on the date the inconsistency was triggered, per alternative source, for example a data warehouse. | "12JAN2021" | |||||||||
| Good Faith Extension | Indicator that reflects whether a good faith extension has been applied to the inconsistency clock end date. | "Yes (with original clock end date, extended clock end date, and reason)", "No" | |||||||||
| DHS SAVE Manual Verification Indicator | An indicator that reflects whether DHS SAVE (Systematic Alien Verification for Entitlements) was used to manually verify an application member's attestation of lawful presence status. - N/A – The inconsistency was not related to immigration status. - Yes Successful – Alien ID was provided by consumer and lawful presence was determined = Yes using DHS SAVE. - Not Successful – Alien ID was provided but lawful presence could not be verified. - Not Attempted – Alien ID was either: - Not provided and not used - Provided but not used for resolution |
"N/A", "Yes Successful", "Not Successful", "Not Attempted" | |||||||||
| • 5.1.2 Review Unit: Verify Inconsistency Adjudication Timeline - Verify the consumer provided documents within the regulatory timeframe for inconsistency resolution. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | Inconsistency Identifier | ||||||||||
| 0 | Inconsistency Sub-Type | ||||||||||
| 0 | Inconsistency Status | ||||||||||
| 0 | Adjudication History | ||||||||||
| 0 | Inconsistency Clock End Date | ||||||||||
| 0 | Inconsistency Clock End Date (Alternative) | ||||||||||
| Inconsistency Adjudication Date | An alternative date that the manual verification of an inconsistency was concluded, per a system different from the original source. Such a system could be a data warehouse. | "12JAN2021" | |||||||||
| 0 | Good Faith Extension | ||||||||||
| • 5.1.3 Review Unit: Verify Application Member Names - Determine whether the name(s) provided on the application reasonably match the consumer’s name(s) reflected in consumer submitted documents. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | First Name | ||||||||||
| 0 | Middle Name | ||||||||||
| 0 | Last Name | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | Inconsistency Identifier | ||||||||||
| 0 | Inconsistency Status | ||||||||||
| 0 | Adjudication History | ||||||||||
| 0 | Relevant Consumer Documents | ||||||||||
| 0 | All Consumer Documents | ||||||||||
| Escalation Guidance | Indicates whether an application was escalated to proper authorities for review and guidance. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| • 5.1.4 Review Unit: Verify Document Authenticity - Validate the authenticity of documents submitted by the consumer. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | Inconsistency Identifier | ||||||||||
| 0 | Inconsistency Status | ||||||||||
| 0 | Adjudication History | ||||||||||
| 0 | Relevant Consumer Documents | ||||||||||
| • 5.1.5 Review Unit: Verify Document Expiration Dates - Determine if the documents submitted by the consumer were not expired and/or valid to adjudicate an Inconsistency based on the age of the document based on SBE policy. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | First Name | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | Inconsistency Identifier | ||||||||||
| 0 | Inconsistency Sub-Type | ||||||||||
| 0 | Inconsistency Status | ||||||||||
| 0 | Adjudication History | ||||||||||
| 0 | Relevant Consumer Documents | ||||||||||
| 0 | All Consumer Documents | ||||||||||
| 0 | Inconsistency Adjudication Date | ||||||||||
| Consumer Documents Issue Date | "12JAN2021" | ||||||||||
| Consumer Documents Expiration Date | Date of expiry of the consumer submitted document. | "12JAN2021" | |||||||||
| Consumer Income Document Effective Start Date | The effective start date of the income document as submitted by the consumer. | "12JAN2021" | |||||||||
| Consumer Income Document Effective End Date | The effective end date of the income document as submitted by the consumer. | "12JAN2021" | |||||||||
| 5.2 Review Module: Inconsistency Sufficiency Review | |||||||||||
| • 5.2.1 Review Unit: Verify Citizenship Sufficiency - Verify consumer submitted documents are sufficient to resolve a citizenship inconsistency for those application versions with citizenship inconsistencies. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | First Name | First name of application member. | |||||||||
| 0 | Middle Name | Middle name of application member. | |||||||||
| 0 | Last Name | Last name of application member. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Inconsistency Identifier | A unique identifier for an inconsistency generated as a result of unsuccessful electronic verifications performed by the Exchange. | |||||||||
| 0 | Inconsistency Sub-Type | A field that describes the sub type of inconsistency that was generated by the Exchange. | |||||||||
| 0 | Inconsistency Status | An indicator that reflects the current status. | |||||||||
| 0 | Adjudication History | A description of the history of adjudicating an inconsistency. | |||||||||
| 0 | Relevant Consumer Documents | A list of documents provided by the consumer to adjudicate a specific inconsistency, including name, date received, and any other relevant information. | |||||||||
| 0 | All Consumer Documents | A list of all consumer documents received by the Exchange associated to the members of an application, including the type(s) of documents received, the date(s) the documents were received and the mode they were received. | |||||||||
| 0 | DHS SAVE Manual Verification Indicator | An indicator that reflects whether DHS SAVE (Systematic Alien Verification for Entitlements) was used to manually verify an application member's attestation of lawful presence status. - N/A – The inconsistency was not related to immigration status. - Yes Successful – Alien ID was provided by consumer and lawful presence was determined = Yes using DHS SAVE. - Not Successful – Alien ID was provided but lawful presence could not be verified. - Not Attempted – Alien ID was either: - Not provided and not used - Provided but not used for resolution |
|||||||||
| Non-Citizen ID Indicator | Indicates whether the consumer provided a Non-Citizen ID. | "Yes – Non-Citizen ID number was used to resolve the issue", "No – Non-Citizen ID number was not used to resolve the issue" | |||||||||
| I-94 Number Indicator | Indicates whether the consumer provided an I-94 number. | "Yes – I-94 number was used to resolve the issue", "No – I-94 number was not used to resolve the issue" | |||||||||
| Attempt Made to DHS SAVE Indicator | Indicates whether the Manual Adjudicator made an attempt to DHS SAVE. | "Yes – DHS SAVE was used to resolve the issue", "No – DHS SAVE was not used to resolve the issue" | |||||||||
| • 5.2.2 Review Unit: Verify Immigration Sufficiency - Verify consumer submitted documents are sufficient to resolve an immigration inconsistency for those application versions with immigration inconsistencies. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan / Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e. the creation and subsequent changes or updates made to an application during a Plan / Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | First Name | First name of application member. | |||||||||
| 0 | Middle Name | Middle name of application member. | |||||||||
| 0 | Last Name | Last Name of application member. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Inconsistency Identifier | A unique identifier for an inconsistency generated as a result of unsuccessful electronic verifications performed by the Exchange. | |||||||||
| 0 | Inconsistency Sub-Type | A field that describes the sub type of inconsistency that was generated by the Exchange. | |||||||||
| 0 | Inconsistency Status | An indicator that reflects the current status. | |||||||||
| 0 | Adjudication History | A description of the history of adjudicating an inconsistency. | |||||||||
| 0 | All Consumer Documents | A list of all consumer documents received by the Exchange associated to the members of an application, including the type(s) of documents received, the date(s) the documents were received and the mode they were received. | |||||||||
| 0 | DHS SAVE Manual Verification Indicator | An indicator that reflects whether DHS SAVE (Systematic Alien Verification for Entitlements) was used to manually verify an application member's attestation of lawful presence status. - N/A – The inconsistency was not related immigration status. - Yes Successful – Alien ID was provided by consumer and lawful presence was determined = Yes using DHS SAVE. - Not Successful – Alien ID was provided but lawful presence could not be verified. - Not Attempted – Alien ID was either: - Not provided and not used - Provided but not used for resolution |
|||||||||
| 0 | Non-Citizen ID Indicator | Indicates whether the consumer provided an Alien ID. | |||||||||
| 0 | I-94 Number Indicator | Indicates whether the consumer provided an I-94 number. | |||||||||
| 0 | Attempt Made to DHS SAVE Indicator | Indicates whether the Manual Adjudicator made an attempt to DHS SAVE. | |||||||||
| • 5.2.3 Review Unit: Verify Annual Income Sufficiency - Verify consumer submitted documents are sufficient to resolve an annual income inconsistency for those application versions with annual income inconsistencies. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | First Name | First name of application member. | |||||||||
| 0 | Middle Name | Middle name of application member. | |||||||||
| 0 | Last Name | Last name of application member. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Attested Annual Household Income | The amount of annual income an application member attested to on the application. | |||||||||
| 0 | Inconsistency Identifier | A unique identifier for an inconsistency generated as a result of unsuccessful electronic verifications performed by the Exchange. | |||||||||
| 0 | Inconsistency Sub-Type | A field that describes the sub type of inconsistency that was generated by the Exchange. | |||||||||
| 0 | Inconsistency Status | An indicator that reflects the current status. | |||||||||
| 0 | Adjudication History | A description of the history of adjudicating an inconsistency. | |||||||||
| 0 | Relevant Consumer Documents | A list of documents provided by the consumer to adjudicate a specific inconsistency, including name, date received, and any other relevant information. | |||||||||
| 0 | All Consumer Documents | A list of all consumer documents received by the Exchange associated to the members of an application, including the type(s) of documents received, the date(s) the documents were received and the mode they were received. | |||||||||
| 0 | DHS SAVE Manual Verification Indicator | An indicator that reflects whether DHS SAVE (Systematic Alien Verification for Entitlements) was used to manually verify an application member's attestation of lawful presence status. - N/A – The inconsistency was not related to immigration status. - Yes Successful – Alien ID was provided by consumer and lawful presence was determined = Yes using DHS SAVE. - Not Successful – Alien ID was provided but lawful presence could not be verified. - Not Attempted – Alien ID was either: - Not provided and not used - Provided but not used for resolution |
|||||||||
| 0 | Non-Citizen ID Indicator | Indicates whether the consumer provided a Non-Citizen ID. | |||||||||
| 0 | I-94 Number Indicator | Indicates whether the consumer provided an I-94 number. | |||||||||
| 0 | Attempt Made to DHS SAVE Indicator | Indicates whether the Manual Adjudicator made an attempt to DHS SAVE. | |||||||||
| Consumer Documents Reflected in Manual Income Verification Result | Consumer documents reflected in standard or custom tool / method / process for manual verification. | "1040" | |||||||||
| • 5.2.4 Review Unit: Verify ESC MEC Sufficiency - Verify consumer submitted documents are sufficient to resolve an ESC MEC inconsistency for those application versions with ESC MEC inconsistencies. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | First Name | First name of application member. | |||||||||
| 0 | Middle Name | Middle name of application member. | |||||||||
| 0 | Last Name | Last name of application member. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Inconsistency Identifier | A unique identifier for an inconsistency generated as a result of unsuccessful electronic verifications performed by the Exchange. | |||||||||
| 0 | Inconsistency Sub-Type | A field that describes the sub type of inconsistency that was generated by the Exchange. | |||||||||
| 0 | Inconsistency Status | An indicator that reflects the current status. | |||||||||
| 0 | Adjudication History | A description of the history of adjudicating an inconsistency. | |||||||||
| 0 | All Consumer Documents | A list of all consumer documents received by the Exchange associated to the members of an application, including the type(s) of documents received, the date(s) the documents were received and the mode they were received. | |||||||||
| 0 | Escalation Guidance | Indicates whether an application was escalated to proper authorities for review and guidance. | |||||||||
| 0 | DHS SAVE Manual Verification Indicator | An indicator that reflects whether DHS SAVE (Systematic Alien Verification for Entitlements) was used to manually verify an application member's attestation of lawful presence status. - N/A – The inconsistency was not related to immigration status. - Yes Successful – Alien ID was provided by consumer and lawful presence was determined = Yes using DHS SAVE. - Not Successful – Alien ID was provided but lawful presence could not be verified. - Not Attempted – Alien ID was either: - Not provided and not used - Provided but not used for resolution |
|||||||||
| 0 | Non-Citizen ID Indicator | Indicates whether the consumer provided a Non-Citizen ID. | |||||||||
| 0 | I-94 Number Indicator | Indicates whether the consumer provided an I-94 number. | |||||||||
| 0 | Attempt Made to DHS SAVE Indicator | Indicates whether the Manual Adjudicator made an attempt to DHS SAVE. | |||||||||
| • 5.2.5 Review Unit: Verify Non-ESC MEC Sufficiency - Verify consumer submitted documents are sufficient to resolve a Non-ESC MEC inconsistency for those application versions with Non-ESC MEC inconsistencies. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | First Name | First name of application member. | |||||||||
| 0 | Middle Name | Middle name of application member. | |||||||||
| 0 | Last Name | Last name of application member. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Inconsistency Identifier | A unique identifier for an inconsistency generated as a result of unsuccessful electronic verifications performed by the Exchange. | |||||||||
| 0 | Inconsistency Sub-Type | A field that describes the sub type of inconsistency that was generated by the Exchange. | |||||||||
| 0 | Inconsistency Status | An indicator that reflects the current status. | |||||||||
| 0 | Adjudication History | A description of the history of adjudicating an inconsistency. | |||||||||
| 0 | All Consumer Documents | A list of all consumer documents received by the Exchange associated to the members of an application, including the type(s) of documents received, the date(s) the documents were received and the mode they were received. | |||||||||
| 0 | Escalation Guidance | Indicates whether an application was escalated to proper authorities for review and guidance. | |||||||||
| 0 | DHS SAVE Manual Verification Indicator | An indicator that reflects whether DHS SAVE (Systematic Alien Verification for Entitlements) was used to manually verify an application member's attestation of lawful presence status. - N/A – The inconsistency was not related to immigration status. - Yes Successful – Alien ID was provided by consumer and lawful presence was determined = Yes using DHS SAVE. - Not Successful – Alien ID was provided but lawful presence could not be verified. - Not Attempted – Alien ID was either: - Not provided and not used - Provided but not used for resolution |
|||||||||
| 0 | Non-Citizen ID Indicator | Indicates whether the consumer provided a Non-Citizen ID. | |||||||||
| 0 | Attempt Made to DHS SAVE Indicator | Indicates whether the Manual Adjudicator made an attempt to DHS SAVE. | |||||||||
| • 5.2.6 Review Unit: Verify Incarceration Sufficiency - Verify consumer submitted documents are sufficient to resolve an incarceration inconsistency for those application versions with incarceration inconsistencies. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan / Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e. the creation and subsequent changes or updates made to an application during a Plan / Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person. | |||||||||
| 0 | As of Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | First Name | First name of application member. | |||||||||
| 0 | Middle Name | Middle name of application member. | |||||||||
| 0 | Last Name | Last Name of application member. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Inconsistency Identifier | A unique identifier for an inconsistency generated as a result of unsuccessful electronic verifications performed by the Exchange. | |||||||||
| 0 | Inconsistency Sub-Type | A field that describes the sub type of inconsistency that was generated by the Exchange. | |||||||||
| 0 | Inconsistency Status | An indicator that reflects the current status. | |||||||||
| 0 | Adjudication History | A description of the history of adjudicating an inconsistency. | |||||||||
| 0 | All Consumer Documents | A list of all consumer documents received by the Exchange associated to the members of an application, including the type(s) of documents received, the date(s) the documents were received and the mode they were received. | |||||||||
| 0 | Escalation Guidance | Indicates whether an application was escalated to proper authorities for review and guidance. | |||||||||
| 0 | DHS SAVE Manual Verification Indicator | An indicator that reflects whether DHS SAVE (Systematic Alien Verification for Entitlements) was used to manually verify an application member's attestation of lawful presence status. - N/A – The inconsistency was not related to immigration status. - Yes Successful – Alien ID was provided by consumer and lawful presence was determined = Yes using DHS SAVE. - Not Successful – Alien ID was provided but lawful presence could not be verified. - Not Attempted – Alien ID was either: - Not provided and not used - Provided but not used for resolution |
|||||||||
| 0 | Non-Citizen ID Indicator | Indicates whether the consumer provided a Non-Citizen ID. | |||||||||
| 0 | I-94 Number Indicator | Indicates whether the consumer provided an I-94 number. | |||||||||
| 0 | Attempt Made to DHS SAVE Indicator | Indicates whether the Manual Adjudicator made an attempt to DHS SAVE. | |||||||||
| 5.3 Review Module: Inconsistency Conclusion | |||||||||||
| • 5.3.1 Review Unit: Verify Inconsistency Conclusion Reflected in the Exchange - Verify the Inconsistency conclusion reached by the SBE Operator was reflected correctly in the SBE's database. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | Inconsistency Identifier | ||||||||||
| 0 | Inconsistency Sub-Type | ||||||||||
| 0 | Inconsistency Status | ||||||||||
| • 5.3.2 Review Unit: Verify APTC/QHP Eligibility Adjustment - Verify that the eligibility determinations and policy status on the SBE's database reflected the Inconsistency expiration. If the Inconsistency expiration resulted in QHP and/or APTC ineligibility, then the policy should have been terminated, canceled, or have an adjusted max APTC Amount. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | |||||||||
| 0 | Insurance Policy Status | The status of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Inconsistency Identifier | A unique identifier for an inconsistency generated as a result of unsuccessful electronic verifications performed by the Exchange. | |||||||||
| 0 | Inconsistency Sub-Type | A field that describes the sub type of inconsistency that was generated by the Exchange. | |||||||||
| 0 | Inconsistency Status | An indicator that reflects the current status. | |||||||||
| 0 | Inconsistency Adjudication Date | An alternative date that the manual verification of an inconsistency was concluded, per a system different from the original source. Such a system could be a data warehouse. | |||||||||
| Inconsistency Expiration Date | The data of expiration for an inconsistency, set by the manual verification. | "12JAN2021" | |||||||||
| 0 | QHP Eligibility Indicator | Indicates if the Exchange determines an applicant is eligible for QHP. | |||||||||
| 0 | APTC Eligibility Indicator | Indicates if member is eligible for APTC. | |||||||||
| 0 | Member-Level Allocated APTC Amount | Allocated APTC Amount is the amount that is allocated to the policy based on the amount the tax household has elected without consideration for amounts that are reallocated from other policies. The final amount of APTC that is applied takes into consideration the amounts that are left over from policies. | |||||||||
| 0 | Maximum APTC Amount | The maximum advanced payment tax credit amount for which the tax household is eligible for. | |||||||||
| • 5.3.3 Review Unit: Verify Income Verification Tool (IVT) Inconsistency Conclusion Reflected Properly - Verify that the Inconsistency status on the SBE's database is consistent with the conclusion of the manual adjudicator. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | Attested Annual Household Income | ||||||||||
| 0 | Consumer Income Documented Amount | The amount of total annual tax income of the tax household calculated by the inconsistency verification worker based on documentation the application member provided. | |||||||||
| 0 | Inconsistency Identifier | ||||||||||
| 0 | Inconsistency Sub-Type | ||||||||||
| 0 | Inconsistency Status | ||||||||||
| Manual Income Verification Result | Outcome of income verification performed by manual reviewers to assess compatibility between attested and documented income. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 6. Review Area: SEP Adjudication and Conclusion | |||||||||||
| 6.1 Review Module: General SEP Adjudication Review Procedures | |||||||||||
| • 6.1.1 Review Unit: Verify SEP Document Submission Timeline - Verify the consumer submitted documents were submitted within the regulatory timeframe for SEP pre-enrollment verification. | |||||||||||
| Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | "0123456789" | |||||||||
| Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | "A123456", "12345678", "A1-2024-MD" -- (an example of a generated Application Identifier for the Plan Year 2024 review for the state of MD) | |||||||||
| Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | "1", "2", "01/22/2020" | |||||||||
| Application Submission Date | A field that is used to reflect the date that an application was submitted. | "12JAN2021" | |||||||||
| Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | "12345678" | |||||||||
| As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | "yyyy-mm-dd-hh. mm." | |||||||||
| 0 | First Name | ||||||||||
| 0 | Middle Name | ||||||||||
| 0 | Last Name | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| SEP Type | The type of SEP | "Adoption", "Newborn", "Marriage", "Relocation", "Loss of MEC" | |||||||||
| SEP Manual Adjudication Identifier | A unique identifier for a SEP manual review performed by the Exchange. | "123456789" | |||||||||
| SEP Adjudication History | A description of the history of adjudicating a SEP. | "This SEP was resolved on 01-01-2020 using an Birth Certificate. DHS SAVE was not used." | |||||||||
| SEP Relevant Consumer Documents | A list of documents provided by the consumer to adjudicate SEP; including name, date received, and any other relevant information. | "Birth Certificate (Received on 01-01-2020) via Mailroom" | |||||||||
| SEP All Consumer Documents | A list of all consumer documents received by the Exchange associated to the members of an application, including the type(s) of documents received, the date(s) the documents were received and the mode they were received. | "Birth Certificate (Received on 01-01-2020) via Mailroom, Passport (Received on 02-01-2020) uploaded to web site, 1040 (Received on 03-01-2020) via Mailroom" | |||||||||
| SEP Manual Adjudication Status | Outcome of the manual SEP verification adjudication. | "Expired", "Obsolete", "Resolved", "Running" | |||||||||
| SEP Manual Adjudication Clock End Date | Date when the SEP manual adjudication ends. | "12JAN2021" | |||||||||
| SEP Good Faith Extension | Indicator that reflects whether a good faith extension has been applied to the inconsistency clock end date. | "Yes (with original clock end date, extended clock end date, and reason)", "No" | |||||||||
| • 6.1.2 Review Unit: Verify SEP Adjudication Timeline - Verify whether the SEP application was adjudicated within the regulatory timeframe. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | SEP Type | ||||||||||
| 0 | SEP Manual Adjudication Identifier | ||||||||||
| 0 | SEP Adjudication History | ||||||||||
| SEP Manual Adjudication Date | Date when the SEP was manually adjudicated. | "12JAN2021" | |||||||||
| 0 | SEP Manual Adjudication Status | ||||||||||
| 0 | SEP Good Faith Extension | ||||||||||
| • 6.1.3 Review Unit: Verify Application Member Names - Verify whether the name(s) provided on the application reasonably match the consumer's name reflected in consumer submitted documents. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | First Name | ||||||||||
| 0 | Middle Name | ||||||||||
| 0 | Last Name | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | SEP Type | ||||||||||
| 0 | SEP Manual Adjudication Identifier | ||||||||||
| 0 | SEP Adjudication History | ||||||||||
| 0 | SEP Relevant Consumer Documents | ||||||||||
| 0 | SEP All Consumer Documents | ||||||||||
| 0 | SEP Manual Adjudication Status | ||||||||||
| SEP Escalation Guidance | Indicates whether an application was escalated to proper authorities for review and guidance. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| • 6.1.4 Review Unit: Verify Document Authenticity - Verify whether the consumer submitted documents are authentic. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | First Name | ||||||||||
| 0 | Middle Name | ||||||||||
| 0 | Last Name | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | SEP Type | ||||||||||
| 0 | SEP Manual Adjudication Identifier | ||||||||||
| 0 | SEP Adjudication History | ||||||||||
| 0 | SEP Relevant Consumer Documents | ||||||||||
| 0 | SEP All Consumer Documents | ||||||||||
| 0 | SEP Manual Adjudication Status | ||||||||||
| 0 | SEP Manual Adjudication Clock End Date | ||||||||||
| • 6.1.5 Review Unit: Verify QLE Dates - Verify whether the consumer submitted documents reflect acceptable life event dates for eligibility. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | First Name | ||||||||||
| 0 | Middle Name | ||||||||||
| 0 | Last Name | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | SEP Type | ||||||||||
| 0 | SEP Manual Adjudication Identifier | ||||||||||
| 0 | SEP Adjudication History | ||||||||||
| 0 | SEP Relevant Consumer Documents | ||||||||||
| 0 | SEP All Consumer Documents | ||||||||||
| 0 | SEP Manual Adjudication Status | ||||||||||
| 0 | SEP Manual Adjudication Clock End Date | ||||||||||
| 0 | SEP Good Faith Extension | ||||||||||
| 0 | SEP Escalation Guidance | ||||||||||
| 6.2 Review Module: Conclusion of SEP Manual Adjudication | |||||||||||
| • 6.2.1 Review Unit: Verify SEP Conclusion Reflected in SBE's database - Verify the SEP conclusion reached by the manual reviewer was reflected correctly in the SBE's database. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | Insurance Policy Identifier | ||||||||||
| 0 | Insurance Policy Status | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | SEP Type | ||||||||||
| 0 | SEP Manual Adjudication Identifier | ||||||||||
| 0 | SEP Adjudication History | ||||||||||
| 0 | SEP Relevant Consumer Documents | ||||||||||
| 0 | SEP All Consumer Documents | ||||||||||
| 0 | SEP Manual Adjudication Status | ||||||||||
| 0 | SEP Escalation Guidance | ||||||||||
| • 6.2.2 Review Unit: Verify Enrollment per SEP Conclusion - Verify the SEP eligibility determination and policy status reflected in the SBE's database is based on the conclusion reached by the manual reviewer. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | Insurance Policy Identifier | ||||||||||
| 0 | Insurance Policy Status | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | SEP Type | ||||||||||
| 0 | SEP Manual Adjudication Identifier | ||||||||||
| 0 | SEP Adjudication History | ||||||||||
| 0 | SEP Relevant Consumer Documents | ||||||||||
| 0 | SEP All Consumer Documents | ||||||||||
| 0 | SEP Manual Adjudication Status | ||||||||||
| 0 | SEP Escalation Guidance | ||||||||||
| 7. Review Area: Eligibility Determinations | |||||||||||
| 7.1 Review Module: Verify QHP Residency Eligibility Determination | |||||||||||
| • 7.1.1 Review Unit: Confirm QHP Residency was Conducted - This test is performed to verify the consumer provided documents within the regulatory time frame for SEP pre-enrollment verification. | |||||||||||
| Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | "0123456789" | |||||||||
| Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | "A123456", "12345678", "A1-2024-MD" -- (an example of a generated Application Identifier for the Plan Year 2024 review for the state of MD) | |||||||||
| Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | "1", "2", "01/22/2020" | |||||||||
| Application Submission Date | A field that is used to reflect the date that an application was submitted. | "12JAN2021" | |||||||||
| Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | "12345678" | |||||||||
| As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | "yyyy-mm-dd-hh. mm." | |||||||||
| 0 | Application Creation Date | A field that is used to reflect the date that an application was created prior to being submitted. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| QHP Residency Eligibility Determination Date | Date when the application member QHP Residency date was determined. | "12JAN2021" | |||||||||
| QHP Residency Eligibility Indicator | Indicates whether the applicant was determined to be QHP Residency eligible. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| • 7.1.2 Review Unit: Confirm QHP Residency was Concluded Properly - Determine whether member was properly determined QHP Residency Eligible based on their attested residency. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| Tax Filer Indicator | Applicant attesting to being a tax filer within a tax household. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Tax Dependent Indicator | Applicant attesting to being a dependent within a tax household. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | Home Street Address | Applicant home street address. | |||||||||
| 0 | Home City | Applicant home city. | |||||||||
| 0 | Home State Code | Applicant home state code. | |||||||||
| 0 | Home Zip Code | Applicant home zip code. | |||||||||
| Mailing Street Address | Applicant mailing street address. | "123 Forrest Street" | |||||||||
| Mailing City | Applicant mailing city. | "McLean" | |||||||||
| Mailing State Code | Applicant mailing state code. | "VA" | |||||||||
| Mailing Zip Code | Applicant mailing zip code. | "22102" | |||||||||
| Transient Street Address | Applicant intended future home street address. | "123 Forrest Street" | |||||||||
| Transient City | Applicant intended future home city. | "McLean" | |||||||||
| Transient State Code | Applicant intended future home state code. | "VA" | |||||||||
| Transient Zip Code | Applicant intended future mailing zip code. | "22102" | |||||||||
| Attested Temporary Absence | Indicates whether this application member attests to living outside of the state temporarily. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Attested No Fixed Address | Indicates whether an applicant has no fixed address. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Residency Inconsistency Manual Adjudication Conducted | Indicates whether a Residency verification inconsistency was manually adjudicated. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | QHP Residency Eligibility Indicator | Indicates whether the applicant was determined to be QHP Residency eligible. | |||||||||
| 7.2 Review Module: Verify QHP Eligibility Determination | |||||||||||
| • 7.2.1 Review Unit: Verify QHP Eligibility Determination Was Conducted - Determine whether QHP eligibility was conducted for an application member who requested coverage. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Attested Citizenship Status Indicator | Indicates whether applicant attests he/she is a US citizen. | |||||||||
| 0 | Attested Lawfully Present Status Indicator | Indicates whether an applicant attests to being lawfully present. | |||||||||
| 0 | Attested Incarceration Status Indicator | Indicates whether an application member is incarcerated. | |||||||||
| 0 | QHP Residency Eligibility Indicator | Indicates whether the applicant was determined to be QHP Residency eligible. | |||||||||
| QHP Residency Eligibility Reason | Reason for the given determination for QHP Residency eligibility. | "Applicant residency is out of state" | |||||||||
| QHP Eligibility Determination Date | Date when the application member's QHP eligibility was determined. | "12JAN2021" | |||||||||
| 0 | QHP Eligibility Indicator | Indicates if the Exchange determines an applicant is eligible for QHP. | |||||||||
| QHP Eligibility Reason | Reason for the given determination for QHP eligibility. | "Applicant is incarcerated", "Applicant is neither a citizen or has lawful presence", "Applicant meets all QHP eligibility criteria" | |||||||||
| Attested Non-Perjury Indicator | Indicates that the insurance applicant certifies that attestations are true under penalty of perjury. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| • 7.2.2 Review Unit: Verify QHP Eligibility Determination Was Concluded Properly - Determine whether QHP Eligibility Status was set properly based on the application member’s attestations and verifications. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Non-Perjury Indicator | Indicates that the insurance applicant certifies that attestations are true under penalty of perjury. | |||||||||
| Attested Information Change Reported Indicator | Indicates that the insurance applicant understands that changed information needs to be reported. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Attested Citizenship Status Indicator | Indicates whether applicant attests he/she is a US citizen. | |||||||||
| 0 | Attested Lawfully Present Status Indicator | Indicates whether an applicant attests to being lawfully present. | |||||||||
| 0 | Attested Incarceration Status Indicator | Indicates whether an application member is incarcerated. | |||||||||
| Attested Incarceration Pending Disposition Indicator | Indicates whether an applicant attested to being in pending disposition for incarceration. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | Residency Verification Result | The final determination on whether the Exchange was able to verify the consumer’s attestation. | |||||||||
| 0 | QHP Eligibility Determination Date | Date when the application member's QHP eligibility was determined. | |||||||||
| 0 | QHP Eligibility Indicator | Indicates if the Exchange determines an applicant is eligible for QHP. | |||||||||
| 7.3 Review Module: Verify APTC Eligibility Determination | |||||||||||
| • 7.3.1 Review Unit: Verify APTC Eligibility Determination Was Conducted - Verify that APTC Verification occurred. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| Tax Filing Status | Tax filing status of an applicant. | "Single", "Married", "Married Filing Separately" | |||||||||
| 0 | Application Creation Date | A field that is used to reflect the date that an application was created prior to being submitted. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Attested Lawfully Present Status Indicator | Indicates whether an applicant attests to being lawfully present. | |||||||||
| 0 | FPL Percentage Per Attested Income | Income as a percentage of the Federal Poverty Level (FPL) amount, calculated per advanced payment tax credit rules published by the treasury based on information provided by the consumer. | |||||||||
| 0 | Attested ESC Offer | Indicates whether an applicant is eligible for Employer Sponsored health coverage. | |||||||||
| 0 | Non-ESC MEC Verification Reason | The findings used to set the final verification result in corroborating the consumer's attestation. | |||||||||
| 0 | APTC Eligibility Date | Date when the APTC eligibility was determined for an application member. | |||||||||
| 0 | APTC Eligibility Indicator | Indicates if member is eligible for APTC. | |||||||||
| • 7.3.2 Review Unit: Verify APTC Eligibility Determination Was Concluded Properly - Determine whether the APTC eligibility indicator was set properly. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Tax Filing Status | Tax filing status of an applicant. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Attested Lawfully Present Status Indicator | Indicates whether an applicant attests to being lawfully present. | |||||||||
| 0 | FPL Percentage Per Attested Income | Income as a percentage of the Federal Poverty Level (FPL) amount, calculated per advanced payment tax credit rules published by the treasury based on information provided by the consumer. | |||||||||
| 0 | Attested Non-ESC MEC Offer | Indicates whether the applicant attests to being enrolled in non-employer sponsored health coverage. | |||||||||
| Attested ESC Offer | Indicates whether an applicant is eligible for Employer Sponsored health coverage. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | Non-ESC MEC Verification Result | Indicator denoting the verification result of a Non-ESC MEC verification. | |||||||||
| 0 | QHP Eligibility Indicator | Indicates if the Exchange determines an applicant is eligible for QHP. | |||||||||
| 0 | APTC Eligibility Indicator | Indicates if member is eligible for APTC. | |||||||||
| APTC Eligibility Reason | Reason for how the given APTC eligibility determination was reached. | "Applicant has employee sponsored coverage (ESC)", "Income is out of FPL range", "Applicant meets all APTC eligibility criteria" | |||||||||
| Special Rule For Non-Citizens Override Indicator | Indicates whether an applicant who is lawfully present, with income below the 100% FPL, but is ineligible for Medicaid by reason of immigration status, making them eligible for APTC. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 7.4 Review Module: Verify SEP Eligibility Determination | |||||||||||
| • 7.4.1 Review Unit: Confirm SEP Eligibility Determination Was Concluded Properly - Determine whether SEP eligibility was determined properly for an application version based on all application member attestations. Determine whether the SEP start and end dates properly reflect the QLE attestation date. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | |||||||||
| 0 | Insurance Policy Status | The status of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Birth Date | Birth Date of an application member. | |||||||||
| Application Enrollment Period Type | The enrollment period for the creation of the application. | "Open Enrollment", "Special Enrollment" | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Attested Circumstance Change Type | The circumstance change type attested by the applicant. | "Adoption", "Newborn", "Marriage", "Relocation", "Loss of MEC" | |||||||||
| Attested Circumstance Change Date | The date the circumstance change occurred. | "12JAN2021" | |||||||||
| Attested Person Recognized Tribe Indicator | Indicates if a person attested to being a member of a federally recognized tribe, band, nation, or community. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Medicaid Denied Indicator | Indicates whether an applicant has been denied eligibility for Medicaid in the last 60 days. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | Medicaid Denied Date | Date that an applicant was denied eligibility for Medicaid. | |||||||||
| Moved From Foreign Country Within Last 60 Days Indicator | Indicates whether the applicant attested to moving from a foreign country to the USA within the last 60 days. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Coverage 60 Days Before Move Indicator | Indicates whether the application member attested to having MEC within 60 days before the attested move date. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Lived In No QHP Zone Within 60 Days Before Move Indicator | Indicates whether the applicant attested to moving from a service area where no QHP was available through the Exchange within the last 60 days. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Coverage 60 Days Before Marriage Indicator | Indicates whether the application member attested to having MEC within 60 days before the attested marriage date. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Lived in No QHP Zone Within 60 Days Before Marriage Indicator | Indicates whether the applicant or the spouse attested to living in a service area where no QHP was available through the Exchange within 60 days before the marriage. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Lived In Foreign Country 60 Days Before Marriage Indicator | Indicates whether the applicant or the spouse attested to living in a foreign country or U.S. territory within 60 days before the marriage. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | QHP Eligibility Indicator | Indicates if the Exchange determines an applicant is eligible for QHP. | |||||||||
| 0 | Member-Level Allocated APTC Amount | Allocated APTC Amount is the amount that is allocated to the policy based on the amount the tax household has elected without consideration for amounts that are reallocated from other policies. The final amount of APTC that is applied takes into consideration the amounts that are left over from policies. | |||||||||
| Exchange Applied SEP Indicator | Indicator that marks the SEP that was applied by the exchange. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Exchange Applied SEP Start Date | The date that the exchange applied SEP started or will start. | "12JAN2021" | |||||||||
| Exchange Applied SEP End Date | The date that the exchange applied SEP ended or will end. | "12JAN2021" | |||||||||
| Exchange Applied SEP Determination Date | The date that the exchange applied SEP was determined for the application version. | "12JAN2021" | |||||||||
| SEP Eligibility Indicator | Indicator that marks which SEP the application is eligible for based on the application member's attestation. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | SEP Type | The type of SEP. | |||||||||
| SEP Eligibility Start Date | The date that the application SEP eligibility started or will start. | "12JAN2021" | |||||||||
| SEP Eligibility End Date | The date that the application SEP eligibility ended or will end. | "12JAN2021" | |||||||||
| SEP Eligibility Determination Date | The date when the application members SEP eligibility was determined. | "12JAN2021" | |||||||||
| 0 | SEP Manual Adjudication Status | Outcome of the manual SEP verification adjudication. | |||||||||
| SEP Manual Adjudication Indicator | Indicates if the SEP application was manually adjudicated by the exchange. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| • 7.4.2 Review Unit: Confirm Electronic SEP Verification Performed - Determine if an SEP Electronic Verification was performed. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Identifier | ||||||||||
| Latest Policy Record | For a specific policy, if multiple versions exist, this indicator will represent the latest version for that policy. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | Insurance Policy Status | ||||||||||
| 0 | Insurance Policy Start Date | ||||||||||
| 0 | Insurance Policy End Date | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | Member-Level Allocated APTC Amount | ||||||||||
| 0 | Exchange Applied SEP Indicator | ||||||||||
| 0 | Exchange Applied SEP Start Date | ||||||||||
| 0 | Exchange Applied SEP End Date | ||||||||||
| 0 | Exchange Applied SEP Determination Date | ||||||||||
| 0 | SEP Eligibility Indicator | ||||||||||
| 0 | SEP Type | ||||||||||
| 0 | SEP Eligibility Start Date | ||||||||||
| 0 | SEP Eligibility End Date | ||||||||||
| 0 | SEP Eligibility Determination Date | ||||||||||
| SEP Auto-Verification Inconsistency Result | Indicator denoting the verification result of a SEP Auto-Verification. | "Yes", "No", "Success", "Failure", "Verified", "Inconsistency Found" | |||||||||
| SEP Inconsistency Identifier | A unique identifier for an inconsistency generated as a result of unsuccessful electronic verifications of SEP coverage performed by the Exchange. | "123456789" | |||||||||
| 0 | SEP Manual Adjudication Indicator | ||||||||||
| • 7.4.3 Review Unit: Confirm Effective Coverage Start Date and Best SEP Determination Was Concluded Properly - Determine whether the effective coverage start date was properly determined per the type of SEP QLE and the policy creation date or the plan selected date. This Review Unit also determines whether the best SEP QLE was selected properly for an application version. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | |||||||||
| 0 | Insurance Policy Status | The status of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| Insurance Policy Selected Date | Date when the insurance policy was selected. | "12JAN2021" | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Attested Circumstance Change Type | The circumstance change type attested by the applicant. | |||||||||
| 0 | Attested Circumstance Change Date | The date the circumstance change occurred. | |||||||||
| 0 | Exchange Applied SEP Indicator | Indicator that marks the SEP that was applied by the exchange. | |||||||||
| 0 | Exchange Applied SEP Start Date | The date that the exchange applied SEP started or will start. | |||||||||
| 0 | Exchange Applied SEP End Date | The date that the exchange applied SEP ended or will end. | |||||||||
| 0 | Exchange Applied SEP Determination Date | The date that the exchange applied SEP was determined for the application version. | |||||||||
| 0 | SEP Type | The type of SEP. | |||||||||
| 0 | SEP Eligibility Start Date | The date that the application SEP eligibility started or will start. | |||||||||
| 0 | SEP Eligibility End Date | The date that the application SEP eligibility ended or will end. | |||||||||
| 0 | SEP Eligibility Determination Date | The date when the application members SEP eligibility was determined. | |||||||||
| 0 | SEP Manual Adjudication Indicator | Indicates if the SEP application was manually adjudicated by the exchange. | |||||||||
| 7.5 Review Module: Verify Max APTC | |||||||||||
| • 7.5.1 Review Unit: Verify Max APTC Was Calculated Properly - Determine if the SBE calculated the max APTC amount correctly based on the application member's applicable Second Lowest Cost Silver Plan (SLSCP), FPL percentage, Tax Household Size, and whether the correct Applied APTC is given based on the application member's selected QHP. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | |||||||||
| 0 | Insurance Policy Status | The status of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Policy Applied APTC Amount | The amount of APTC that has been applied to the policy. | |||||||||
| Essential Health Benefits Policy Premium Amount | Essential Health Benefits (EHB) policy premium amount in a given month. | "2000" | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | FPL Percentage Per Attested Income | Income as a percentage of the Federal Poverty Level (FPL) amount, calculated per advanced payment tax credit rules published by the treasury based on information provided by the consumer. | |||||||||
| 0 | Attested Annual Household Income | The amount of annual income an application member attested to on the application. | |||||||||
| Federal Poverty Level Amount | This is the Federal Poverty Level (FPL), as published on the first day of the regular enrollment period for coverage by a qualified health plan (QHP) through an Exchange for a calendar year, for a family size equal to tax household size without regard to lawful presence status. | "60000" | |||||||||
| Second Lowest Cost Silver Plan Premium Amount | This is the essential health benefits EHB adjusted monthly premium of the Second Lowest Cost Silver Plan (SLCSP) (or sum of SLCSPs) that cover the primary taxpayer, his or her spouse, and their tax dependents for use in computing max advance payments of the premium tax credit. | "2000" | |||||||||
| 0 | Maximum APTC Amount | The maximum advanced payment tax credit amount for which the tax household is eligible for. | |||||||||
| Issuer Effectuation Status | Indicates whether the applicant paid their initial premium for a given policy as indicated by issuer. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| • 7.5.2 Review Unit: Verify FPL Amount Was From Correct Coverage Year - Determine if the FPL amount used in the calculation corresponds to the correct coverage year, state code, and tax household size. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Attested Tax Household Size | Attested number of individuals in the application related to tax filer members. | |||||||||
| 0 | Federal Poverty Level Amount | This is the Federal Poverty Level (FPL), as published on the first day of the regular enrollment period for coverage by a qualified health plan (QHP) through an Exchange for a calendar year, for a family size equal to tax household size without regard to lawful presence status. | |||||||||
| 0 | Issuer Effectuation Status | Indicates whether the applicant paid their initial premium for a given policy as indicated by issuer. | |||||||||
| • 7.5.3 Review Unit: Confirm the Applied APTC Does Not Exceed the Max APTC Amount - Determine if the applied APTC for a given application version is less than or equal to the SBE's calculated max APTC amount for the application version. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | |||||||||
| 0 | Insurance Policy Status | The status of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Policy Applied APTC Amount | The amount of APTC that has been applied to the policy. | |||||||||
| 0 | Essential Health Benefits Policy Premium Amount | Essential Health Benefits (EHB) policy premium amount in a given month. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Member-Level Allocated APTC Amount | Allocated APTC Amount is the amount that is allocated to the policy based on the amount the tax household has elected without consideration for amounts that are reallocated from other policies. The final amount of APTC that is applied takes into consideration the amounts that are left over from policies. | |||||||||
| 0 | Maximum APTC Amount | The maximum advanced payment tax credit amount for which the tax household is eligible for. | |||||||||
| 0 | Issuer Effectuation Status | Indicates whether the applicant paid their initial premium for a given policy as indicated by issuer. | |||||||||
| • 7.5.4 Review Unit: Confirm the Applied APTC Amount Does Not Exceed the Household Essential Health Benefits Premium Amount - Determine if the sum of plan EHB premium amounts for all application members enrolled in a given policy is greater than or equal to the applied APTC (refer to the Glossary for definition) amount for that policy. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | |||||||||
| 0 | Insurance Policy Status | The status of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Policy Applied APTC Amount | The amount of APTC that has been applied to the policy. | |||||||||
| 0 | Essential Health Benefits Policy Premium Amount | Essential Health Benefits (EHB) policy premium amount in a given month. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Issuer Effectuation Status | Indicates whether the applicant paid their initial premium for a given policy as indicated by issuer. | |||||||||
| 8. Review Area: Enrollment Redeterminations | |||||||||||
| 8.1 Review Module: Verify Annual Redeterminations Were Concluded Properly | |||||||||||
| • 8.1.1 Review Unit: Verify Enrollee Group Assignments - Determine whether the enrollee was assigned correctly to a problematic group based on their tax form receipt and annual household income during annual auto re-enrollment. | |||||||||||
| Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | "0123456789" | |||||||||
| Application Identifier | A unique identifier for an application household (or households) during a given Plan / Benefit Year. | "A123456", "12345678", "A1-2024-MD" -- (an example of a generated Application Identifier for the Plan Year 2024 review for the state of MD) | |||||||||
| Application Version | A sequence number that is used to distinguish various events for an application, i.e. the creation and subsequent changes or updates made to an application during a Plan / Benefit Year. | "1", "2", "01/22/2020" | |||||||||
| Person Tracking Number | A unique identification number that is used to identify a person. | "12345678" | |||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | Attested Annual Household Income | ||||||||||
| Enrollee Tax Return Access Authorization | Indicates whether the tax data used in the application can be used at the time of renewal. | ||||||||||
| IRS Income Data Available | Indicates whether or not Income verification data was found in the IRS. | ||||||||||
| IRS Tax Form Receipt | Indicates whether the tax household anchor attested that the tax household reconciled to premium tax credits on last year's tax return. | ||||||||||
| IRS Annual Tax Household Income Amount | The Annual Tax Household Income amount returned from IRS. | ||||||||||
| Failure to Reconcile Indicator | Indicates whether the tax household anchor attested that the tax household reconciled to premium tax credits on last year's tax return. | ||||||||||
| Auto Re-enrolled for past 2 Benefit Years | Indicates whether an application member was auto re-enrolled in the past two benefit years. | ||||||||||
| No IRS data for past 3 Benefit Years | Indicates whether the Exchange has not received updated IRS data for the application member within the past three years. | ||||||||||
| No updates to application for past 2 Benefit Years | Indicates whether an application member has not updated their application within the past two benefit years. | ||||||||||
| • 8.1.2 Review Unit: Verify APTC Eligibility Determination per Annual Redetermination - Determine whether enrollees that requested financial assistance were properly granted APTC eligibility for the upcoming benefit year based on re-enrollment eligibility factors. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | "0123456789" | ||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | "A123456", "12345678", "A1-2024-MD" -- (an example of a generated Application Identifier for the Plan Year 2024 review for the state of MD) | ||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | "1", "2", "01/22/2020" | ||||||||
| Application Submission Date | A field that is used to reflect the date that an application was submitted. | "12JAN2021" | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | "12345678" | ||||||||
| As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | "yyyy-mm-dd-hh. mm." | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | APTC Eligibility Indicator | Indicates if member is eligible for APTC. | |||||||||
| Auto Re-Enrollment Eligible Indicator | Indicates whether an application member has passed the state exchange's auto re-enrollment criteria. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Auto Re-Enrollment Denial Reason | The reason an application member was denied auto re-enrollment and APTC Eligibility is terminated. | "Failure to provide sufficient documentation to allow Auto-reenrollment" | |||||||||
| 8.2 Review Module: Medicaid/CHIP Periodic Data Matching (PDM) | |||||||||||
| • 8.2.1 Review Unit: Medicaid/CHIP PDM Requested Properly - Determine whether the SBE requested a PDM on APTC eligible application members per the PDM planned request scheduled date. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Policy Applied APTC Amount | The amount of APTC that has been applied to the policy. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Medicaid/CHIP PDM Scheduled Date | The date during the benefit year when the Medicaid/CHIP PDM is scheduled to occur. | "12JAN2021" | |||||||||
| Medicaid/CHIP PDM Actual Run Date | Date when Medicaid/CHIP PDM was executed for application member. | "12JAN2021" | |||||||||
| Medicaid/CHIP Confirmed Dual Enrollment | Medicaid CHIP was confirmed to be dually enrolled and applicant has not resolved issue within the allotted resolution period. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Medicaid/CHIP Confirmed Expiration Date | The date when applicant failed to resolve their Medicaid/CHIP dual enrollment issue within the allotted resolution period. | "12JAN2021" | |||||||||
| • 8.2.2 Review Unit: Medicaid/CHIP PDM Confirmation of Dual Enrollment Was Concluded Properly - Determine if the SBE properly terminated APTC eligibility for consumers that are dually enrolled in Medicare, Medicaid, or CHIP per PDMs conducted in a given Benefit Year. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | APTC Eligibility Date | Date when the APTC eligibility was determined for an application member. | |||||||||
| 0 | APTC Eligibility Indicator | Indicates if member is eligible for APTC. | |||||||||
| 0 | Medicaid/CHIP PDM Scheduled Date | The date during the benefit year when the Medicaid/CHIP PDM is scheduled to occur. | |||||||||
| 0 | Medicaid/CHIP PDM Actual Run Date | Date when Medicaid/CHIP PDM was executed for application member. | |||||||||
| 0 | Medicaid/CHIP Confirmed Dual Enrollment | Medicaid CHIP was confirmed to be dually enrolled and applicant has not resolved issue within the allotted resolution period. | |||||||||
| 0 | Medicaid/CHIP Confirmed Expiration Date | The date when applicant failed to resolve their Medicaid/CHIP dual enrollment issue within the allotted resolution period. | |||||||||
| 8.3 Review Module: Verify Failure to Reconcile (FTR) Periodic Data Match | |||||||||||
| • 8.3.1 Review Unit: Verify FTR PDM Check Was Initiated - Determine whether an FTR PDM was performed for each application that received APTC the prior year. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | Insurance Policy Start Date | ||||||||||
| 0 | Insurance Policy End Date | ||||||||||
| 0 | Policy Applied APTC Amount | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| FTR PDM Scheduled Date | The date during the benefit year when the FTR PDM is scheduled to occur. | "12JAN2021" | |||||||||
| FTR PDM Actual Run Date | Date when FTR PDM was executed for application member. | "12JAN2021" | |||||||||
| FTR PDM Confirmed Expiration | The applicant has failed to resolve the FTR issue within the given resolution period. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| FTR PDM Confirmed Expiration Date | The date when applicant failed to resolve their FTR issue within the allotted resolution period. | "12JAN2021" | |||||||||
| Received APTC Prior Year | Indicates that an application member has received APTC the previous year | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| • 8.3.2 Review Unit: Verify Whether Confirmed FTR PDM Was Concluded Properly - Determine whether the system properly terminated APTC eligibility based on a confirmed FTR response from the IRS. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | Insurance Policy Start Date | ||||||||||
| 0 | Insurance Policy End Date | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| 0 | APTC Eligibility Date | ||||||||||
| 0 | APTC Eligibility Indicator | ||||||||||
| 0 | FTR PDM Scheduled Date | ||||||||||
| 0 | FTR PDM Confirmed Expiration Date | ||||||||||
| 0 | Received APTC Prior Year | ||||||||||
| 8.4 Review Module: Death Periodic Data Matching | |||||||||||
| • 8.4.1 Review Unit: Death PDM Initiated Properly - Determine whether a Death PDM check was conducted for the relevant population per the PDM scheduled date | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Policy Applied APTC Amount | The amount of APTC that has been applied to the policy. | |||||||||
| 0 | Birth Date | Birth Date of an application member. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | SSN Verification Date | Date when SSN attestation verification was conducted. | |||||||||
| 0 | SSN Verification Result | The final determination on whether the Exchange was able to verify the consumers attestation. | |||||||||
| 0 | SSN Verification Reason | The findings used to set the final verification result in corroborating the consumer's attestation. | |||||||||
| Death PDM Scheduled Date | The date during the benefit year when the Death PDM is scheduled to occur. | "12JAN2021" | |||||||||
| Death PDM Actual Run Date | Date when Death PDM was executed for application member. | "12JAN2021" | |||||||||
| Death Date | Death date of applicant. | "12JAN2021" | |||||||||
| • 8.4.2 Review Unit: Death PDM Concluded Properly - Determine whether an application member who has a confirmed death status from the Death PDM had their QHP Eligibility terminated. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | QHP Eligibility Indicator | Indicates if the Exchange determines an applicant is eligible for QHP. | |||||||||
| 0 | Death PDM Scheduled Date | The date during the benefit year when the Death PDM is scheduled to occur. | |||||||||
| 0 | Death Data Present | SSA indicated that applicant is associated with death data. | |||||||||
| 0 | Death Date | Death date of applicant. | |||||||||
| Death Resolution Status | Status used to indicate whether or not an applicant has resolved death-related issues with application. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 8.5 Review Module: Medicare Periodic Data Matching | |||||||||||
| • 8.5.1 Review Unit: Medicare PDM Initiated Properly - Determine whether a Medicare PDM check was initiated properly for the relevant population per the Medicare PDM scheduled date. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Policy Applied APTC Amount | The amount of APTC that has been applied to the policy. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Medicare PDM Scheduled Date | The date during the benefit year when the Medicare PDM is scheduled to occur. | "12JAN2021" | |||||||||
| Medicare PDM Actual Run Date | Date when Medicare PDM was executed for application member. | "12JAN2021" | |||||||||
| • 8.5.2 Review Unit: Medicare PDM Concluded Properly - Determine whether an application member who has a confirmed duplicate coverage status from the Medicare PDM had their APTC and QHP Eligibility terminated or set to 0. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | QHP Eligibility Indicator | Indicates if the Exchange determines an applicant is eligible for QHP. | |||||||||
| 0 | APTC Eligibility Date | Date when the APTC eligibility was determined for an application member. | |||||||||
| 0 | APTC Eligibility Indicator | Indicates if member is eligible for APTC. | |||||||||
| 0 | Medicare PDM Scheduled Date | The date during the benefit year when the Medicare PDM is scheduled to occur. | |||||||||
| 0 | Medicare PDM Actual Run Date | Date when Medicare PDM was executed for application member. | |||||||||
| Medicare Dual Enrollment Status | Indicates whether an applicant is dually enrolled in Medicare and Non ESC MEC. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Medicare Resolution Status | Status used to indicate whether or not an applicant has resolved Medicare dual-enrollment issues with application. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 9. Review Area: Enrollment Reconciliation | |||||||||||
| 9.1 Review Module: Verify Enrollment Determination | |||||||||||
| • 9.1.1 Review Unit: Verify Household Enrollment Based on SBE's APTC Eligibility - Determine whether the household, or member(s) of a household, was properly enrolled to receive APTC payments based on the APTC eligibility of all household members for each financial span. | |||||||||||
| Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | "0123456789" | |||||||||
| Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | "A123456", "12345678", "A1-2024-MD" -- (an example of a generated Application Identifier for the Plan Year 2024 review for the state of MD) | |||||||||
| Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | "1", "2", "01/22/2020" | |||||||||
| Application Submission Date | A field that is used to reflect the date that an application was submitted. | "12JAN2021" | |||||||||
| Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | "12345678" | |||||||||
| As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | "yyyy-mm-dd-hh. mm." | |||||||||
| 0 | Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| Multiple Tax Household Indicator | Indicates whether the insurance application contains multiple tax households. | True, "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | Tax Filing Status | Tax filing status of an applicant. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | APTC Eligibility Indicator | Indicates if member is eligible for APTC. | |||||||||
| 0 | Member-Level Allocated APTC Amount | Allocated APTC Amount is the amount that is allocated to the policy based on the amount the tax household has elected without consideration for amounts that are reallocated from other policies. The final amount of APTC that is applied takes into consideration the amounts that are left over from policies. | |||||||||
| • 9.1.2 Review Unit: Confirm Enrollment Effectuation Reconciliation - Confirm whether policy effectuation was reconciled and processed properly. | |||||||||||
| 0 | Tax Household Grouping Identifier | ||||||||||
| 0 | Application Identifier | ||||||||||
| 0 | Application Version | ||||||||||
| 0 | Application Submission Date | ||||||||||
| 0 | Person Tracking Number | ||||||||||
| 0 | As-Of-Date | ||||||||||
| 0 | Insurance Policy Identifier | ||||||||||
| 0 | Insurance Policy Status | ||||||||||
| 0 | Insurance Policy Start Date | ||||||||||
| 0 | Insurance Policy End Date | ||||||||||
| 0 | Application Event Type | ||||||||||
| 0 | Application Event Source | ||||||||||
| 0 | Attested Coverage Request | ||||||||||
| 0 | Attested Financial Assistance Request | ||||||||||
| Exchange Effectuation Status | Indicates whether the applicant paid their initial premium for a given policy as indicated by Exchange. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| 0 | Issuer Effectuation Status | ||||||||||
| Issuer Reconciliation Data Matching Issue Indicator For Effectuation Status | Indicates whether the issuer and Exchange had data matching issues during reconciliation for effectuation status. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Issuer Reconciliation Data Matching Issue Resolution For Effectuation Status | Indicates the action taken to resolve data discrepancies between the issuer and Exchange for effectuation status. | "Exchange keeps data value and tells issuer to update their data records", "Exchange adopts issuer data values" | |||||||||
| • 9.1.3 Review Unit: Confirm Issuer and the SBE Coverage Span Reconciliation - Determine whether coverage spans reported by the issuer match that of the SBE with respect to benefit start date and benefit end date. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Status | The status of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Exchange Benefit Start Date | Benefit start date for the QHP coverage period as reflected by Exchange records. | "12JAN2021" | |||||||||
| Issuer Benefit Start Date | Benefit start date for the QHP coverage period as reflected by Issuer records. | "12JAN2021" | |||||||||
| Issuer Reconciliation Data Matching Issue Indicator For Benefit Start Date | Indicates whether Issuer and Exchange had data matching issues during reconciliation for benefit start date. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Issuer Reconciliation Data Matching Issue Resolution For Benefit Start Date | Indicates the action taken to resolve data discrepancies between the Issuer and Exchange for benefit start date. | "Exchange keeps data value and tells issuer to update their data records", "Exchange adopts issuer data values" | |||||||||
| Exchange Benefit End Date | Benefit end date for the QHP coverage period as reflected by Exchange records. | "12JAN2021" | |||||||||
| Issuer Benefit End Date | Benefit end date for the QHP coverage period as reflected by Issuer records. | "12JAN2021" | |||||||||
| Issuer Reconciliation Data Matching Issue Indicator For Benefit End Date | Indicates whether Issuer and Exchange had data matching issues during reconciliation for benefit end date. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Issuer Reconciliation Data Matching Issue Resolution For Benefit End Date | Indicates the action taken to resolve data discrepancies between the Issuer and Exchange for benefit end date. | "Exchange keeps data value and tells issuer to update their data records", "Exchange adopts issuer data values" | |||||||||
| • 9.1.4 Review Unit: Confirm APTC Value Reconciliation - Determine whether applied APTC values reported by the issuer match that of the SBE for every financial span of the Benefit Year. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Exchange Policy Applied APTC Amount | The policy applied APTC the Exchange reported in their reconciliation output (RCNO) file that was sent to the issuer. | "2000" | |||||||||
| Issuer Policy Applied APTC Amount | The amount of APTC that has been applied to the policy as reflected by Issuer records. | "2000" | |||||||||
| Issuer Total Premium Amount | Issuer total premium amount provided during the reconciliation process. | "2000" | |||||||||
| Issuer Reconciliation Data Matching Issue Indicator For Applied APTC Amount | Indicates whether Issuer and Exchange had data matching issues during reconciliation for applied APTC amount. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| Issuer Reconciliation Data Matching Issue Resolution For Applied APTC Amount | Indicates the action taken to resolve data discrepancies between the issuer and Exchange for applied APTC amount. | "Exchange keeps data value and tells issuer to update their data records", "Exchange adopts issuer data values" | |||||||||
| 10. Review Area: Payments | |||||||||||
| 10.1 Review Module: Verify Net APTC Calculated Payments | |||||||||||
| • 10.1.1 Review Unit: Aggregated Enrollment-Payment Comparison - Determine whether the aggregated pre-payment APTC amount at the application level is reasonably compatible with the aggregated applied APTC amount for an application for the Benefit Year. | |||||||||||
| Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | "0123456789" | |||||||||
| Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | "A123456", "12345678", "A1-2024-MD" -- (an example of a generated Application Identifier for the Plan Year 2024 review for the state of MD) | |||||||||
| Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | "1", "2", "01/22/2020" | |||||||||
| Application Submission Date | A field that is used to reflect the date that an application was submitted. | "12JAN2021" | |||||||||
| As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | "yyyy-mm-dd-hh. mm." | |||||||||
| 0 | Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Policy Applied APTC Amount | The amount of APTC that has been applied to the policy. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 11. Review Area: Plan Management | |||||||||||
| 11.1 Review Module: Verify QHP Status | |||||||||||
| • 11.1.1 Review Unit: Confirm QHP Is Certified for the Coverage Year - Determine whether payments were made to applicants enrolled in non-certified, de-certified, or withdrawn QHP plans. | |||||||||||
| Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | "0123456789" | |||||||||
| Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | "A123456", "12345678", "A1-2024-MD" -- (an example of a generated Application Identifier for the Plan Year 2024 review for the state of MD) | |||||||||
| Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | "1", "2", "01/22/2020" | |||||||||
| Application Submission Date | A field that is used to reflect the date that an application was submitted. | "12JAN2021" | |||||||||
| Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | "12345678" | |||||||||
| As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | "yyyy-mm-dd-hh. mm." | |||||||||
| 0 | Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | |||||||||
| 0 | Insurance Policy Status | The status of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| Selected Insurance Plan Identifier | Insurance plan identifier for the policy selected by the applicant. | "99969OH100010" | |||||||||
| Plan Certified Indicator | Indicates whether the selected QHP by the consumer has been certified. | "True", "False", "Yes", "No", "Y", "N" | |||||||||
| QHP Suppression Date | Date of QHP suppression. | "12JAN2021" | |||||||||
| QHP Unsuppression Date | Date of QHP unsuppression. | "12JAN2021" | |||||||||
| QHP Suppression Reason | Reason for the suppression of a QHP. | "Exchange freezes new enrollments" | |||||||||
| • 11.1.2 Review Unit: Confirm No New Enrollments for Suppressed QHP - Determine whether payments were made to suppressed QHP policies associated to new enrolled applicants. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | |||||||||
| 0 | Insurance Policy Status | The status of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Policy Applied APTC Amount | The amount of APTC that has been applied to the policy. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Selected Insurance Plan Identifier | Insurance plan identifier for the policy selected by the applicant. | |||||||||
| 0 | QHP Suppression Date | Date of QHP suppression. | |||||||||
| 0 | QHP Unsuppression Date | Date of QHP unsuppression. | |||||||||
| 0 | QHP Suppression Reason | Reason for the suppression of a QHP. | |||||||||
| • 11.1.3 Review Unit: Confirm Member Enrolled in QHP Offered In Their Plan Area - Determine whether payments were made to suppressed QHP policies associated to new enrolled applicants. | |||||||||||
| 0 | Tax Household Grouping Identifier | Identifier that groups application members within a single tax household. | |||||||||
| 0 | Application Identifier | A unique identifier for an application household (or households) during a given Plan/Benefit Year. | |||||||||
| 0 | Application Version | A sequence number that is used to distinguish various events for an application, i.e., the creation and subsequent changes or updates made to an application during a Plan/Benefit Year. | |||||||||
| 0 | Application Submission Date | A field that is used to reflect the date that an application was submitted. | |||||||||
| 0 | Person Tracking Number | A unique identification number that is used to identify a person across benefit years. | |||||||||
| 0 | As-Of-Date | a date/timestamp indicating when an application was created or modified due to updates made by the consumer or system generated events. | |||||||||
| 0 | Insurance Policy Identifier | A unique identifier assigned by the exchange to the insurance policy. | |||||||||
| 0 | Insurance Policy Status | The status of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy Start Date | The start date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Insurance Policy End Date | The end date of the Policy which the applicants are enrolled in. | |||||||||
| 0 | Home State Code | Applicant home state code. | |||||||||
| 0 | Application Event Type | The different types of events that led to the creation or change, update to an application. | |||||||||
| 0 | Application Event Source | The origin event that led to the creation or change, update to an application. | |||||||||
| 0 | Attested Coverage Request | An indicator that the application member attested to applying for coverage. | |||||||||
| 0 | Attested Financial Assistance Request | An indicator that the application member attested to requesting financial assistance. | |||||||||
| 0 | Selected Insurance Plan Identifier | Insurance plan identifier for the policy selected by the applicant. | |||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |