Program Overview
Starting in contract year 2027, all Medicare Advantage (MA) plans are required by CMS to supply provider directory data for display on the Medicare Plan Finder. This session covered the integration requirements, technical specifications, implementation timeline, and action items needed for plans to achieve compliance.
Technical Specifications
Data Format & File Structure
- Provider data must be supplied in machine-readable JSON or FHIR format
- Files follow a standard client naming convention
- URLs (not API endpoints) are provided to CMS for file access
- CMS crawls and validates URLs daily; corrections are required when errors are found
- Phase 2 update: PC Key / EIN identifiers from Phase 1 are no longer required; a new identifier format applies going forward
RevSpring Role in Delivery
- RevSpring handles the heavy lifting on the delivery side
- Generates XML/XLSX files based on CMS standards
- Ensures files are accessible for daily CMS crawls
- Ensures FHIR-based files are fully compliant and ready for download
- Performs gap analysis and integrity checks during the testing window to ensure network codes match provider files exactly
Data Recipients
- CMS receives provider information for all individual / enrollee-only plans
- Includes Local PPO, HMO, and network-based plans
- (FHIR) API endpoints are not directly exposed to CMS; URLs replace endpoint exposure
Q&A
Q: How frequently will files be generated?
Still being determined. Plans should work directly with their RevSpring Customer Success partner to establish specific cadences. The expectation is that files will update automatically when changes are made to provider data.
Q: Can testing begin with partial data?
Yes. Plans can begin testing with currently available data and add supplemental data when it is ready. Consideration should be given to timing and providing feedback on any changes that emerge.
Q: What did Phase 2 change regarding identifiers?
The PC Key / EIN requirement from Phase 1 is no longer relevant in Phase 2. Plans must use the updated identifier format going forward.
Q: Are FHIR API endpoints exposed to CMS?
No. FHIR API endpoints are not directly exposed to CMS. Instead, URLs are provided, allowing CMS to access and process FHIR-based files through the URL approach.
Q: Will URLs change?
CMS does not expect URLs to change. If a URL change becomes necessary, advance communication would be provided.
Q: How often does CMS crawl URLs?
CMS crawls URLs per contract annually and publishes validation results on a similar cadence.
Q: What does the testing process look like for health plans?
RevSpring validates your network code in the provider file as part of the integrity check. Plans are required to verify network OS values and ensure provider data matches expected standards.
Action Items
- Submit primary technical and business contacts to RevSpring immediately.
- Formally confirm participation in Wave One testing.
- Submit completed network crosswalk by May 15, 2026.
- Continue attending weekly RevSpring sessions updates, FAQ answers, and new data will be shared on an ongoing basis.
- Retain and note business decision contacts discussed during sessions.
- Reach out to your RevSpring Customer Success partner for plan-specific technical questions.
Next Steps
RevSpring will continue compiling answers to incoming questions and providing as much communication as possible through the weekly meeting series. Plans are encouraged to reach out to their Customer Success partner at any time with specific questions rather than waiting for the next session.
Additional information is posted on the RevSpring support page. Plans should monitor these resources for updates.