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How to submit a complex case web form



Health Insurance Marketplace

July 24, 2024

Use the Complex Case Web Form for Help with Complex Cases

If you are unable to resolve a specific issue on a consumer or tax household’s application for Marketplace coverage, you may be dealing with a complex case. Complex cases are not policy questions or general questions about the Marketplace, but are specific issues unique to an application.

Complex case form

If you are experiencing a complex case, the complex case web form [ https://mats-cms-ccrms.my.salesforce-sites.com/complexcase ] can be used to submit this case for investigation by the Complex Case Help Center (CCHC) team. This form can also be used to report when a consumer communicates that they have been enrolled in a health plan or their health plan has been changed without their knowledge or consent. When reporting these possible fraud cases, you do not need to attempt to resolve the issue with the Marketplace call center before submitting the complex case.

Before you attempt to submit a complex case, you should:


* Attempt to resolve the case at the Marketplace Call Center. (Not required if consumer reports they were enrolled in a Marketplace plan without their knowledge or consent or had their plan changed without their knowledge or consent).
* Confirm that the consumer’s contact information is up to date on their application.
* Collect all necessary information, including the consumer’s name, email, telephone number, address, and a summary of the issue at hand and the results desired by the consumer. If you have supporting documents you would like to submit as a part of your complex case, make sure to have these available as well.

In order to assist you with using the form, CMS has a Complex Case Web Form User Guide [ https://www.cms.gov/marketplace/technical-assistance-resources/training-materials/complex-case-user-guide.pdf ] that goes over the different pages of the form and the information needed in detail. You can also check out these webinar slides [ https://www.cms.gov/marketplace/technical-assistance-resources/training-materials/complex-case-presentation.pdf ] for more helpful tips about using the form.


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*"Have questions? "*"Certified Application Counselors (CACs) should contact the CAC mailbox at CACQuestions@cms.hhs.gov, EAPs should contact ""EAPQuestions@cms.hhs.gov" <EAPQuestions@cms.hhs.gov>"_,_ and Navigators should reach out to their Project Officer."




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