2 Days
No Surprises Act update mandate
Commercial health plans have just two business days to update provider directories—or risk paying the difference for out-of-network care.
The Compliance Landscape
Four Pressures. One Platform to Address Them All.
90 Days
Maximum verification cycle
The NSA mandates 90-day provider data verification. Manual processes make compliance difficult at enterprise scale.
1 in 5
Member experience risk
The NSA requires provider data verification every 90 days. Without automation, health plans struggle to maintain compliance at scale.
Measurable ROI
Higher ROI Per Enrollee
Accurate, centralized provider data reduces grievances, NSA disputes, and the cost of maintaining provider records.
Provider Data Failures Cost Commercial Plans Members and Margin — Not Just Audit Findings.
For commercial plans competing on premium and member experience, dirty provider data isn't a back-office problem. It's a revenue leak, a retention risk, and an NSA liability that compounds every quarter.
- No Surprises Act Liability
- An inaccurate provider listing can trigger out-of-network reimbursement costs, member disputes, and compliance risk. Manual processes rarely meet the two-business-day update requirement.
- Directory-Driven Member Churn
- Over one-third of members will switch health plans for better digital experiences and accurate provider data. Directory inaccuracies drive grievances, disenrollments, and lower member satisfaction.
- Marketplace Network Adequacy Scrutiny
- Marketplace plans must meet time and distance standards, report telehealth providers, and maintain continuous network monitoring to stay certification-ready.
- Multi-Group Network Complexity
- Multiple benefit designs and network tiers make manual provider data management unsustainable—driving operational complexity and NSA risk.
BUILT FOR THE ACCURACY STANDARD CMS NOW REQUIRES
Purpose-built AI for Medicare Advantage operations excellence: directory accuracy, network adequacy, contract and clinical intelligence.
Point Solutions Cost More. Deliver Less.
Commercial plans managing six separate vendor relationships for provider data pay a coordination tax on every workflow. HiLabs replaces the stack with a single AI platform: lower cost, no data silos, one audit trail.
- Lower Cost Over Legacy Vendors
- One platform replaces fragmented point solutions for directory, rosters, credentialing, and contracts — eliminating duplicate data pipelines, integration overhead, and vendor management cost.
- Data Silos Across Workflows
- A provider credentialed in MCred+ flows automatically into Directory Accuracy, NetworkIQ, and ContractsAI — so your data doesn't need to be reconciled across systems before it can be used.
- Audit Trail for Every Workflow
- Every directory update, roster change, credentialing decision, and contract configuration is logged in a single compliance-grade evidence system — so NSA audits, state reviews, and NCQA surveys don't require manual reconstruction.
40%
Zero
One
Health plans partnering with HiLabs stay audit-ready. Continuously.
Measured across Medicare Advantage plans in active production. Real outcomes, not projections.
99%+
Directory accuracy rate post-deployment
97%+
Ghost provider cleansing with zero adequacy impact
80%+
Contract pricing automation, weeks of config to minutes
30+
Markets in active MA production, 2024-25
Transform Provider Data Chaos Into Intelligent Automation
No rip-and-replace, quick go-live. HiLabs integrates with FACETS, QNXT, your credentialing systems and beyond.
Automatically aggregate provider data from multiple systems, formats, and sources, rosters, contracts, EMR feeds, CMS files — into one unified platform. No templates required.
Score and verify every provider record against 300+ authoritative sources — NPI Registry, CAQH, DEA, state boards. Enrich 80+ attributes and flag discrepancies before they reach downstream systems.
Continuously monitor provider data for changes that impact compliance, network adequacy, or member access. Surface ghost providers, license lapses, and adequacy gaps before CMS finds them.
Push validated, enriched provider data directly into FACETS, QNXT, member portals, and analytics systems — with no manual re-entry and a full audit trail on every change.
Built for Every Commercial Plan Leader Who Touches Provider Data.
HiLabs surfaces the right intelligence for every function that carries provider data responsibility from front-line operations to the executive signing the NSA attestation.
- VP / Director of Network Management
- Managing directory compliance across commercial, marketplace, and ASO accounts - each with different update obligations, verification cycles, and benefit tier structures.
- Head of Compliance / Regulatory Affairs
- Accountable for NSA obligations, marketplace certification, and state-level directory standards that vary by market — without a scalable process for keeping up with the velocity of provider change.
- VP of Operations / COO
- Under cost pressure on provider data operations without the headcount budget to match regulatory velocity and looking for automation that doesn't require ripping out current systems.
- Head of Provider Data / Analytics
- Building a reliable data foundation for network adequacy, NSA claims accuracy, and member-facing directory tools- across FACETS, QNXT, and marketplace certification systems that don't share a common provider record.
- CIO and IT leadership
- Integrating provider data pipelines across commercial, ASO, and marketplace lines of business without creating new silos or requiring a 12–18 month build to meet compliance obligations.
- Head of Member Experience
- Watching directory inaccuracy surface in grievances, disenrollments, and NPS scores — knowing that one in five marketplace members couldn't find a covered provider they needed last year.
Network Leadership
Compliance & Regulatory
Operations Leadership
DATA AND ANALYTICS
TECHNOLOGY
Member Experience
Questions Commercial Plans Ask Before Deploying HiLabs.
How does HiLabs help commercial plans meet the No Surprises Act's 2-business-day directory update requirement?
MCheck Directory Accuracy monitors provider data changes daily across 300+ authoritative sources. When a change requires a directory update, the platform surfaces it and routes it through the update pipeline automatically — with enough lead time to consistently meet the NSA 2-business-day obligation. Every update is logged with a timestamp and evidence trail for audit purposes.
Does HiLabs support both fully-insured and self-funded (ASO) group network structures?
Yes. MCheck Roster Automation ingests provider data across fully-insured groups, self-funded ASO accounts, delegated networks, and multi-tier benefit designs without requiring standardized formats from downstream groups. Network tier and benefit design logic is configurable per account — so your commercial book can scale without adding operations headcount.
How does HiLabs track telehealth provider status for ACA marketplace certification?
MCheck Directory Accuracy captures and continuously monitors telehealth status as a distinct provider data dimension, aligned with the 2026 mandatory reporting requirement for marketplace plans. Status changes are detected automatically and routed for directory update — so your certification cycle reflects current telehealth availability without manual data collection from providers.
Can HiLabs handle multi-tier network designs - narrow, broad, and tiered?
Yes. HiLabs supports multi-tier network configurations with tier-specific validation logic, adequacy thresholds, and directory output formatting. Each tier can have distinct NSA update obligations, verification schedules, and reporting outputs — managed in a single platform without separate workflows per tier.
How does HiLabs connect contract terms to NSA cost-sharing obligations and claims adjudication?
MCheck ContractsAI extracts commercial reimbursement terms, fee schedules, and network participation status from PPAs and pushes validated pricing configurations directly to claims systems like FACETS and QNXT. This closes the gap between contract language and what gets adjudicated — eliminating the pricing mismatches that create NSA cost-sharing errors and member disputes.
How quickly can we get from deployment to NSA-compliant directory output?
Most commercial plans are generating NSA-compliant directory output within four weeks of deployment. HiLabs has pre-built connectors for FACETS, QNXT, and HL7 FHIR-compliant systems — integration is designed to be non-disruptive, with no rip-and-replace required. The initial validation run typically surfaces the highest-priority NSA exposure points in the first week.