July 2025
30-day update mandate live
MA plans must update directories within 30 days of any provider change and attest annually to accuracy.
The CMS compliance timeline
Three deadlines. One public benchmark.
Jan 2026
CMS data submission required
MA organizations must make directory data available to CMS for online publication ahead of open enrollment.
Plan Year 2027
Directories go public on Plan Finder
Plan-sourced directory data goes live on Medicare Plan Finder. Public, visible, and scored.
Directory errors are no longer an internal compliance issue.
They're public record
Here's what's at stake for every Medicare Advantage plan still relying on manual directory management.
- 90 Days Disenrollment Period
- A large share of inactive providers in MA directories should not be listed at all, triggering Special Election Periods that let members dis-enroll within 90 days. Dirty data has direct revenue and access to care consequences.
- 80% Incorrect Data
- Behavioral health is the specialty under the most CMS and OIG scrutiny in 2025-26. Gaps and ghost listings here are where audits start.
- 30 Days Deadline
- Every provider change, must be reflected in their directory within 30 days. For plans managing tens of thousands of records across delegated groups, manual processes will miss the window.
- 2027 Approaching Fast
- Directory accuracy feeds STAR ratings, member access scores, and audit findings. Plans that miss the 2027 Plan Finder benchmark will have their performance exposed in direct comparison with competitors.
BUILT FOR THE ACCURACY STANDARD CMS NOW REQUIRES
Purpose-built AI for Medicare Advantage operations excellence: directory accuracy, network adequacy, contract and clinical intelligence.
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.
Crafted to serve the needs of every Medicare Advantage stakeholder.
HiLabs surfaces the right intelligence for every leader who touches Medicaid provider data, from front-line operations to the executive signing the state contract.
- Head of Medicare Advantage
- Accountable for STAR ratings, CMS audit outcomes, and the accuracy of your public Plan Finder directory.
- VP of Network Management
- Managing thousands of provider records across delegated groups under 30-day SLAs that manual processes can't sustain.
- Head of Compliance
- Responsible for CMS attestations, audit response, and ensuring the plan meets evolving directory standards before they become findings.
- Head of Enterprise Data
- Building the data infrastructure compliance, network, and quality teams depend on, and that CMS now evaluates directly.
- CIO and IT leadership
- Integrating provider data pipelines with FACETS, QNXT, and CMS submission systems without disrupting operations.
- Head of Program Integrity
- Tracking directory accuracy as a quality measure, including behavioral health availability and STAR rating implications.
PROGRAM LEADERSHIP
NETWORK AND OPERATIONS
COMPLIANCE AND REGULATORY
DATA AND ANALYTICS
TECHNOLOGY
QUALITY AND INTEGRITY
Questions Medicare Advantage Plans Ask Before Deploying HiLabs.
How does HiLabs help us meet the 2027 CMS Plan Finder submission requirement?
MCheck Directory Accuracy validates and structures your provider directory data in the CMS-required format for Plan Finder submission, automates the 30-day update cycle, and generates annual accuracy attestation documentation automatically — so your compliance team isn't assembling this manually under deadline pressure.
Can HiLabs specifically flag behavioral health directory gaps?
Yes. MCheck Directory Accuracy and NetworkIQ track behavioral health and SUD provider availability as distinct data dimensions, aligned with OIG and CMS scrutiny areas. Ghost provider detection applies with heightened sensitivity to the behavioral health specialty category.
How does HiLabs connect to our existing FACETS or QNXT systems?
HiLabs has pre-built connectors for FACETS and QNXT. Validated provider data and contract pricing outputs push directly into your adjudication systems without manual re-entry. Most plans are live within four weeks of kickoff — no rip-and-replace required.
What does the 30-day update obligation mean operationally, and how does HiLabs automate it?
HiLabs monitors provider data changes daily across 300+ sources. When a provider leaves the network, relocates, loses licensure, or changes status, the system surfaces the change automatically and routes an alert to the right team — with enough lead time to update the directory within the 30-day window without manual intervention.
How quickly can we go from deployment to CMS-ready output?
Most Medicare Advantage plans are generating CMS-ready directory output within four weeks of deployment. The initial ingestion and validation cycle surfaces the accuracy gaps immediately — which many plans find is the most valuable insight in the first 30 days.
Does HiLabs support the annual accuracy attestation documentation CMS requires?
Yes. MCheck Directory Accuracy automatically generates attestation-ready documentation with source citations, accuracy rates by data element, and audit trail records for every provider change — structured to meet CMS attestation requirements at 42 CFR § 422.111(m).