How to Use the Master Review Tool
Did you know that CMS provides review tools that issuers and states can use to
prepare for the QHP Application process? These review tools allow you to check
for errors within your QHP Application that would result in corrections after submission.
Issuers are encouraged to use these tools to identify and
correct data errors prior to submitting application data,
in order to reduce the number of required corrections identified during CMS’ reviews.
States are encouraged to use these tools during their reviews to identify potential
errors in their issuers’ application data that would require issuers to make corrections.
The Master Review Tool aggregates data from the Plans and Benefits,
Service Area, Essential Community Providers/ Network Adequacy, and Prescription Drug Templates,
and serves as a data input file to some of the other stand-alone review tools.
These stand-alone tools include: the Essential Community Providers, or ECP, Tools,
the Non-Discrimination Cost Sharing Review Tool, the Cost Sharing Review Tool,
the Category Class Drug Count Tool, and the Formulary Review Suite.
You can also use the Master Review Tool to conduct the Silver/Gold review, to ensure that an issuer
has at least one silver and one gold plan in every county in which the issuer offers medical plans.
To fully populate the Master Review Tool, you will need:
the Plans and Benefits Template, the Service Area Template,
the Essential Community Providers/Network
Adequacy Template, and the Prescription Drug Template.
Note that some issuers may have multiple Plans and Benefits Templates.
In this scenario, all Plans and Benefits Templates should be uploaded into the tool.
Parent organizations and states can also use the tool to review multiple issuers’ data at once,
and may upload all issuers’ relevant templates into the same Master Review Tool.
Before importing templates, be sure to save each template type in a separate folder. This
is required for the tool to import data properly. To download the Master Review Tool, visit the
Review Tools webpage of the QHP certification website and click on the Master Review Tool link.
You can also download the “Review Process Guide” from this page. This guide provides
step-by-step processes that state regulators can follow to review QHP Applications for
compliance with specific Patient Protection and Affordable Care Act, or PPACA, standards,
including descriptions of the backend functionality of the automated review tools.
Once the Master Review Tool is downloaded, open it in Excel and enable macros. The first tab in the
worksheet gives an overview of the stand-alone tools that use the Master Review Tool for data
input. The second tab includes instructions on using the Master Review Tool. Read both
of these tabs carefully before beginning. Instructions for importing data begin in step 4.
Click the “Import all Plans & Benefits Data” button and select the folder that contains all
the saved Plans & Benefits Templates. Importing this data will populate the “All Plan Data” tab.
In step 5, click the “Import all Service Area Data” button
and select the folder that contains all the saved Service Area Templates.
Importing this data will populate the “All Service Area Data” tab.
After you import service area data in Step 5, you can run the Silver/Gold Plan review.
Click the “Run Silver/Gold Plan Review” button, and if all data is compliant,
the tool will display a message telling you the plans being checked have passed the review.
If any plans do not pass the review, you will be shown the Silver/Gold Output tab, with information
about the counties in which an issuer is not offering both a silver and a gold plan.
If this is the case, issuers will need to decide to alter their plan data in some way,
ensuring they offer at least one silver and one gold plan in each county they cover.
Once an issuer decides how to alter its plans, it’s time to correct the error.
Issuers should make corrections in the Plans and Benefits template,
the Service Area template, or both, save and validate them, and reupload them into the Master
Review Tool. Repeat the review process until all plans meet the Silver/Gold review requirements.
In step 6, click the “Import all ECP Data” button and select the folder that contains all the saved
Essential Community Providers, or ECP, Network Adequacy Templates and associated ECP Worksheets.
Importing this data will populate the “All ECP Data” tab.
Step 7 will ask you whether you have separate Individual and SHOP, or Small Business Health
Options Program, Prescription Drug Templates. Be sure to read the instructions carefully to
answer the question appropriately. Then click the “Import Prescription Drug Data”
button and select the folder that contains all the saved Prescription Drug Templates.
Note that if you selected “Yes” in cell D17, the user must save all templates with either
“IndTemp” or “SHOPTemp” in the file name, or the data will not import. Importing this data will
populate the “All Formulary Tier Data” tab. Once you’ve completed importing the data,
navigate to the remaining tabs to ensure you’ve imported the appropriate data.
The Master Review Tool is now ready for you to import into the stand-alone tools.
If you have questions regarding the QHP Application Review Tools,
please contact the Marketplace Service Desk at CMS_FEPS@cms.hhs.gov, or 855-CMS-1515.
For more information about the QHP Certification Process, visit www.qhpcertification.cms.gov.