6.30.26 Medicare Plan Finder Information Session

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6.30.26 Medicare Plan Finder Information Session

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1. Medicare Plan Finder Phase 2 Overview

  • Final rule basis: Medicare Plan Finder (MPF) Phase 2 stems from CMS final rule 4208, requiring all Medicare Advantage (MA) payers to supply provider directory data for display in CMS's Medicare Plan Finder tool, starting with Contract Year 2027.
  • Two submission formats: Plans may supply data via machine-readable JSON files or FHIR-based JSON files.
  • Delivery mechanism: Files are made available to CMS through an MPF provider directory URL defined in each plan's Health Plan Management System (HPMS), on a per-contract-number, per-contract-year basis. CMS crawls this URL daily, validates the data, and loads anything that passes into Medicare Plan Finder.
  • Annual attestation: Plans must attest annually within HPMS to the accuracy of their provider data, completed by a designated signatory (typically a CEO, COO, or CFO).

2. CMS Key Dates & Timeline

  • CMS testing window: Open May 2026 through the end of August 2026, allowing plans to submit files, receive validation results, and iterate.
  • July 10, 2026: New deadline (announced via memo the prior Wednesday) to populate MPF provider directory URLs in HPMS, regardless of whether supporting files are ready. URLs can be updated later if needed.
  • September 1, 2026: Deadline to complete Contract Year 2027 attestation in HPMS.
  • Early September 2026: MPF plan preview window opens.
  • September 18, 2026: Target date for production-ready data within MPF, ahead of the October 1 go-live.
  • October 1, 2026: Data becomes available to beneficiaries in Medicare Plan Finder.

3. RevSpring Action Plan & Timeline

  • Active testing: RevSpring is in active testing with all clients; appreciation was expressed to clients who have already supplied core files and feedback.
  • August 15, 2026: Target date for RevSpring to receive a production-ready crosswalk of each client's finalized Contract Year 2027 contracts with their Kyruus/RevSpring-provided networks.
  • Production URL delivery: RevSpring will deliver production-ready URLs later this summer, ahead of the September 18 HPMS deadline.
  • July 22, 2026 session: RevSpring will host an additional info session on the production cutover process.
  • CY2027 contract negotiations: RevSpring acknowledged that clients are still finalizing CMS contract negotiations and that not everyone may meet the August 15 crosswalk deadline.
    • Clients unable to meet August 15 should notify their Customer Success partner and Data Operations lead, along with an expected delivery date, so RevSpring can plan accordingly.

4. The July 10 Memo: Two Distinct Requests

  • Request 1 – MPF provider directory URL: Tied to the MPF Phase 2 final rule and CMS's finalized technical guidance issued May 1, 2026. Plans must report a publicly available URL (containing an index file per contract ID) in HPMS by July 10, defined per contract number and contract year.
    • Submitted via the “Manage MPF Provider Directory URLs” page in the MPF Provider Directory module of HPMS.
    • Support for this is included as part of RevSpring's standard provider directory licensing.
  • Request 2 – FHIR provider directory API endpoint: Tied to a separate, earlier CMS rule (CMS-9115, Interoperability and Patient Access, finalized May 2020, effective July 1, 2021). Plans must provide a FHIR server base URL per contract number, accessible by CMS without client registration.
    • CMS confirmed one base URL may cover multiple contract IDs if the FHIR server commingles them.
    • Submitted via the “Manage FHIR Provider Directory API Endpoints” page in the MPF Provider Directory module of HPMS.
    • RevSpring support here is limited to clients who license its separate Provider Directory FHIR API add-on (launched in 2021); it is not part of the standard provider directory offering.

5. How RevSpring Is Supporting Clients

  • MPF provider directory URLs: RevSpring generated per-contract-ID, per-contract-year URLs over the past weekend for clients who supplied Medicare contract ID, plan ID, and plan segment by last Friday; these were distributed via Customer Success or Data Operations leads.
    • Clients still in active testing are being supported through ongoing validation feedback resolution.
    • This support is included in RevSpring's standard provider directory offering for all health plan clients.
  • FHIR provider directory URLs: Clients who already license RevSpring's FHIR Provider Directory API will receive outreach from their Customer Success partner or Data Operations lead with their existing base FHIR URL to enter into HPMS.
    • RevSpring's FHIR API is CMS-conformant, built on HL7 FHIR R4 and the Da Vinci PDex Plan-Net IG, supports per-payer/per-brand endpoints, and keeps public and authenticated provider data consistent.
  • Migrating to RevSpring's FHIR API: Moving existing FHIR endpoints to RevSpring is not feasible by July 10; typical implementation takes roughly 4–6 weeks. Interested clients should contact their Customer Success partner.

6. Q&A Highlights

  • CMS token vs. client registration: Using a CMS-issued security token to access the FHIR API does not conflict with the “no client registration required” rule; this is standard practice for most organizations regardless of FHIR API vendor.
  • No extra action for active MPF testers: Clients already in active MPF testing with URLs posted meet the July 10 testing requirement; no further action is needed for that piece.
  • Materials will be shared: The recording, summarized notes, and slide deck will be distributed after the session for internal reference or sharing with colleagues.
  • Switching FHIR vendors by July 10: Moving existing FHIR provider directory endpoints to RevSpring by July 10 is not possible; RevSpring will work with interested clients on a longer-term transition.
  • Submission validation errors: Clients seeing a failed URL-validation message should reach out to their Customer Success partner and Data Operations lead, as some delays trace back to outstanding network-code-to-contract crosswalks on RevSpring's side.

7. Looking Ahead: MPF Phase 3 & Rule 0057

  • MPF Phase 3: Expected to leverage these same FHIR endpoints to support CMS's newly launched national provider directory.
  • Final rule 0057: Introduces CMS “secret shopper” accuracy audits comparing FHIR API data to what's published on plan member websites, reinforcing both state and federal expectations around provider data accuracy via FHIR.
  • Q3 platform investment: RevSpring is investing in performance upgrades to its FHIR Provider Directory API in Q3 2026 to support increased usage and upcoming CMS mandates.

8. Immediate Action Items

  • Share CMS validation feedback: Send any CMS validation reports or feedback to your Customer Success partner or Data Operations lead for triage.
  • Production-ready CY2027 data by August 15: Be prepared to submit this via email by August 15; notify RevSpring in advance if you anticipate missing this date, along with your expected timeline.
  • Updated crosswalk data: Send any updated network/contract crosswalk data to RevSpring as soon as possible to support the September 18 production target.
  • Attend the July 22 session: Join RevSpring's upcoming info session covering the production cutover process.
  • FHIR API clients: Watch for outreach with your base FHIR URL and enter it into HPMS once received.
  • Post-10/1 feedback: Share any CMS feedback received after the October 1 go-live with RevSpring for support.

 

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