The video outlines the Medicare Plan Finder (MPF) Phase 2 Info Session, focusing on how Medicare Advantage (MA) plans will share provider directory data with CMS for contract year 2027.
Key Summary
Objective: MA plans are required to provide machine-readable directory data (JSON/FHIR-based) to CMS. This allows beneficiaries to see which providers accept specific plans.
Data Hosting: RevSpring will host FHIR-based JSON files via URLs that plans must enter into the Health Plan Management System (HPMS). CMS will crawl these URLs daily to validate and update the MPF tool.
New CMS Clarifications:
Plans must specify if their URL points to standard or FHIR-based JSON.
Directories must only include current, in-network providers and must be updated every 30 days.
All contracted providers, including supplemental benefits (dental, vision, hearing), must be included. Pharmacy data is handled via a separate process.
Implementation Phases:
Wave 1: Final commitment was due May 5th; crosswalk files are due by May 15th.
Wave 2: Target for submissions starting June 30th.
Testing Window: Open from May through the end of August.
Action Items
Immediate (For Wave 1 Plans)
Submit Network Crosswalk File (Due May 15th): Plans must provide a pipe-delimited
.txtfile containing theNetworkCode,MedicareContractID,MedicarePlanID, andMedicareSegmentID.Validation Check: Ensure the
NetworkCodein the crosswalk file exactly matches the code used in your existing provider data feeds to ensure data integrity.
Administrative Tasks
HPMS Data Entry: MA organizations must enter and maintain the directory URLs provided by RevSpring in the HPMS Basic Contract Management module.
Data Scrubbing: Verify that your provider data feeds exclude pharmacy records and provider groups (include individual providers only).
Segment Values: If a plan is not segmented, use the value
000in the segment ID field.
Long-term Compliance
Update 2027 Data: While 2026 data can be used for initial testing, plans must be ready to provide contract year 2027 data by late August for the final production release.
Address Validation Errors: Monitor HPMS for CMS validation results and collaborate with RevSpring to adjust JSON files if errors are identified.