CMS proposes 90-day provider directory checks for Medicare Advantage
A proposed rule would make Medicare Advantage plans verify provider directories every 90 days and publish an accuracy score. What it means for practices.
What is CMS proposing?
On October 16, 2026, CMS released a proposed rule (CMS-4214-P) that would require Medicare Advantage plans to verify and update their provider directory information at least every 90 days, report a directory accuracy score, and display that score on their public directories, starting in 2029. The rule implements the REAL Health Providers Act, Section 6220 of the Consolidated Appropriations Act, 2026. Last week we looked at the new DataSpring standard for measuring provider directory accuracy, and CMS has now taken the same issue a step further.
| When | What |
|---|---|
| December 15, 2026 | Comments due to CMS |
| 2028 | 90-day verification, accuracy reporting, and in-network cost sharing when a listing is wrong |
| 2029 | Accuracy scores displayed on plans' directories |
Why does the 90-day cycle matter?
For anyone who has worked a credentialing desk, directory verification requests are nothing new. They come in from every plan and most offices answer them when they can get to them, but a 90-day requirement would make that hard to keep up. If your group participates with ten Medicare Advantage plans, that works out to roughly forty verification requests a year, or close to one a week, on top of keeping every provider's DataSpring profile (formerly CAQH ProView) attested every 120 days. CMS's own estimate is about 15 minutes per verification, or up to an hour a year for each provider, per plan.
The good news is that CMS's version is more flexible than the DataSpring standard. Plans could verify with claims data, provider attestations and NPPES, not only phone calls. Whether they actually do, or just pick up the phone, will decide how much of this lands on your front desk.
Why will plans care?
What will get the plans' attention is the financial exposure. Beginning in contract year 2028, a member who sees a provider listed as in-network would pay no more than their in-network cost sharing, even if the listing turns out to be wrong; the plan absorbs the difference. Officially, the proposal only requires plans to flag a listing they can't verify as possibly out of date. In my experience, when a plan starts paying for bad data, the first thing it does is clean house and remove any listing it can't confirm. If your office isn't responding to these requests, your providers may drop out of the directory and new patients won't find them.
Who does this affect?
Any practice, group or health system in Medicare Advantage networks is affected, along with billing and credentialing companies managing rosters for clients. Groups with multiple locations, part-time providers or regular turnover will feel it the most, since that is where directory information goes out of date the fastest. The proposal would also require plans to add a term to provider contracts obligating providers to keep their directory information current and accurate.
What should practices do now?
- Assign one person to own directory information for each location: address, phone, accepting new patients, and which providers actually see patients there.
- Treat the DataSpring profile as your master record, because if the information there is wrong, every plan pulling from it will be wrong too.
- Keep a log of roster changes so when a provider leaves or a location closes, every Medicare Advantage plan is notified right away rather than at the next attestation. Under the proposal, plans would have 30 days to update a listing and 5 business days to remove a provider who has left the network, and they can only do that once they hear from you.
- Check every provider's NPPES record. Plans would be allowed to verify your directory listing against it, so a stale practice address there can now show up as an error in every Medicare Advantage directory.
- If the 90-day requirement would be a burden on your office, submit a comment to CMS before the December 15, 2026 deadline (5 p.m. Eastern).
Sources
- The proposed rule, Federal Register document 2026-21420
- CMS press release, Oct. 16, 2026
- Becker's Hospital Review
- Ziurta blog: New provider directory standard means more calls for practices
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About the author
Tony Kuka · Founder, Ziurta
Tony is the founder of Ziurta, a provider enrollment platform for medical practices, health systems, RCM firms, and credentialing companies. He has 30 years in healthcare administration, including 20 building outsourced revenue cycle companies, and founded and sold Medical Business Office and National Credentialing Solutions. He is based in Chattanooga, Tennessee.