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Text of CMS Casework Guidance for Issuers in Federally-Facilitated Marketplaces, Including State Partnership Marketplaces (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Official Guidance]
Mar. 13, 2014

"In most QHP-related matters, the [Health Insurance Marketplace] Call Center and HHS will direct consumers to the QHP issuer to address their concerns, disputes, and grievances. HHS strongly believes the best source for the resolution of issues involving a QHP is the QHP issuer, along with any other appropriate state resource. Consequently, HHS will notify QHP issuers of casework from consumers, providers, and other stakeholders and expects issuers to work in close contact with HHS to facilitate satisfactory resolution of cases within the time periods specified in 45 C.F.R. 156.1010.... The HHS casework tracking system will help provide oversight and accountability for QHP issuers, to help ensure that QHP issuers are appropriately responsive to consumer cases.... HHS will work with consumers and their authorized representatives directly if it becomes apparent that the QHP issuer is not working to resolve the concern, dispute, or grievance pursuant to the regulatory timeframes."

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