Key Summary
Transition to Phase 2: Moves from an optional third-party data exchange (Sunfire Matrix) to a direct data exchange between payers and CMS.
Data Format: Payers must provide data via FHIR-based JSON API files. RevSpring will support this by generating necessary plan bundles and hosting index URLs.
CMS Integration: CMS will crawl these URLs daily to ingest and validate the data for the Medicare Plan Finder tool.
Responsibility: Payers are responsible for the accuracy of provider data and must perform an annual attestation through the HPMS system.
Action Items
1. Identify Contacts & Confirm Participation
Deadline: Due by May 5, 2026.
Identify primary technical and business contacts.
Formally confirm intent to participate in Wave 1.
2. Submit Network Crosswalk File
Deadline: Due by May 15, 2026 (for Wave 1).
Required Fields: NetworkCode, MedicareContractID, MedicarePlanID, MedicareSegmentID, and PlanYear (2027).
Technical Spec: Pipe-delimited
.txtformat; must match theNetworkCodein your provider file.Delivery: Upload to your existing standard delivery location (AWS S3 or GCP).
3. Data Validation
Payers must ensure
MedicareContractIDandNetworkCodeare accurate to avoid validation failures.Verify all required FHIR resources (InsurancePlan, Location, Practitioner, etc.) can be generated in the required format.
4. HPMS Update
Update your Health Plan Management System (HPMS) with the Index File URLs generated by RevSpring to allow CMS crawling.
Note: If your organization cannot meet the May 15 deadline, you will be moved to Wave 2, with testing beginning in early Q3 (after June 30).