How to Use the Data Integrity 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 Data Integrity Tool checks for critical data errors and warns of potential issues
within your QHP Application. This tool can run validation
checks specific to a plan’s coverage type, market type, or child-only offering status.
The tool will produce validation errors for an individual template that contains data errors,
or for inconsistent data between two different templates.
You can use the Data Integrity Tool to run reviews for plans offered on-Exchange,
off-Exchange, and both on- and off-Exchange. CMS recommends you use the Data Integrity
Tool before using other review tools, to ensure the validity of your data
before submitting the templates. To run any of the reviews within
the Data Integrity Tool, you will need a completed Plans & Benefits Template.
Additionally, you may also want to use the Data Integrity Tool to check data in:
the Service Area Template, the Prescription Drug Template,
the Network ID Template, the Business Rules Template,
the Rates Table Template, and the Unified Rate Review Template.
To download the Data Integrity Tool, visit the Review Tools webpage of the QHP certification
website and click on the Data Integrity Tool link. A zip file will be downloaded to your computer.
Within this .zip file, you’ll see: 1. The Data Integrity Tool,
2. The Data Integrity Tool Change Log, if applicable
3. The Data Integrity Tool Frequently Asked Questions Sheet,
4. The Data Integrity Tool Reference List, and 5. The Data Integrity Tool Tip Sheet.
Carefully read the FAQ Sheet and Tip Sheet before using the tool.
To begin using the Data Integrity Tool, open the spreadsheet in Excel, and enable macros.
Before beginning the import process, closely review the Overview, Instructions, and Reference
tabs to learn how the Data Integrity Tool works, and how it will be most beneficial to you.
To begin importing template data, navigate to the Menu tab. Remember,
you must import Plans and Benefits data for the tool to run properly.
Return to the Menu tab and continue to import all other templates you want
to check for validity errors. Once you’ve imported all data, click on the “Validate
All Imported Templates” button for the type of data you’re checking, either on- or off-Exchange.
You will see the validation results in the applicable Validation Errors tab.
Results are categorized as “errors” or “warnings” in the “Error Type” column.
An error represents data that needs to be corrected before submitting the template.
A warning identifies data that may or may not be an error,
and prompts the user to double-check the flagged data to confirm they are correct.
If you receive an error or warning, you should review the information provided.
Issuers will need to make the necessary corrections to their templates.
Once the necessary changes have been made, and the updated templates have been validated and saved,
return to the Data Integrity Tool’s Menu tab and select “Clear On Exchange Validation Errors” or
“Clear Off Exchange Validation Errors,” depending on the data you’re checking.
Re-import the templates to which changes were made.
Note that re-importing a single template will override existing data for that template, so you
do not need to click “Clear ALL Imported Template Data” if changes were not made to every template.
Once you’ve reimported the updated templates,
click on the appropriate “Validate All Imported Templates” button again.
If the templates have successfully been updated to be error- and warning-free,
you will receive a message that says, “No warnings or errors were found.”
If, however, any plans still contain data errors, you will need to go to the Validation
Errors tab and repeat the review process. Continue following these steps until you receive
a message that says, “No warnings or errors were found,” or you’ve reviewed and determined that
the remaining “Warnings” are not applicable and will not result in an error in the application.
Now let’s review examples of data error results in the tool and how issuers can resolve them.
In our first example, after importing the relevant templates and running the on-Exchange
validation check, the applicable “Validation Errors” tab displayed the following error:
one of your plans has a combined in-network individual deductible equal to $6,000
and a corresponding maximum out of pocket, or MOOP, value equal to $3,850.
The deductible is greater than the corresponding MOOP. Please confirm that you have accurately
entered your deductible and MOOP values. This error occurs when the deductible of
a plan exceeds the MOOP of that plan. This is a data error that needs to be corrected.
In the “Validation Errors” tab, you will also see additional fields that will help you pinpoint
where the data error occurred, and which template you need to correct in order to address the error.
To review the error within the tool, click on the linked cell reference under “DIT Cell Reference.”
In this example, the tool navigates to the P&B tab, and places the cursor
to show the cell where the error occurs. Then navigate back to the Validation Errors Tab
and use the Template Filename, Template Worksheet, and Field Name columns to determine which fields
in which template need to be corrected. Open the appropriate template, navigate to
the worksheet identified by the Data Integrity Tool, and locate the data error. In this case,
you would need to determine whether the deductible was too high, or the MOOP was too low,
and make the correction accordingly. Once the correction is made,
save and validate the template, and reimport the corrected template into the tool. Click
“Clear On Exchange Validation Errors” to remove old results, and click “Validate All Imported
Templates” in the On-Exchange Validation box. The Validation Errors tab now shows a message
indicating that no validation errors were found, since the data error was corrected.
In our second example, after running the On-Exchange Validation review, the “Validation
Errors” tab displays the following error: one of your plans is missing rates for Rating Area 12.
This plan is associated with service area ID NCS001.
The error also lists the counties in Rating Area 12 covered by that service area.
This error occurs when a plan is associated to a service area that includes counties in a specific
rating area, but that rating area does not have associated rates in the Rates Table Template.
Use the Template Filename, Template Worksheet, and Template Field Name
columns in the Validation Errors tab to identify where the error occurred,
and the appropriate template you need to correct in order to address the error.
This example indicates that corrections need to be made in either:
The Rates Table Template, adding rates for Rating Area 12 to the template; or
The Service Area Template, removing counties in Rating Area 12 from the plan’s service area.
In this case, we identified the error to be in the Rates Table Template,
and will add rates for Rating Area 12. Open the Rates Table Template, navigate to the
appropriate worksheet, scroll to the first row of empty cells, and insert rates for Rating Area 12.
For a complete list of each state’s rating area,
visit the Market Rating Reforms web page of the CCIIO website at the URL shown on the screen.
Once corrected, save and validate the template, and reimport it into the Data Integrity Tool.
Click the “Clear On Exchange Validation Errors” button to remove old results, and click the
“Validate All Imported Templates” button in the On Exchange Validation box to rerun the review.
The Validation Errors tab now shows a message indicating no validation errors were found,
since the data error was corrected.
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.