Quarterly compliance is over. On both sides of 2027.
Adequacy monitoring for ACA and MA network operations teams.
ACA filings are splintering into 50 state DOI reviews under the 2027 NBPP devolution. MA plans face 30-day directory update windows, annual accuracy attestations, and a CMS Special Election Period when members find bad listings. Radius gives payer network ops a fast, API-driven platform that handles both: monitor directory accuracy, forecast adequacy across QHP and MA networks, and produce audit-ready evidence on demand, at a fraction of the cost of legacy tools.
Ghost networks are no longer a marketing problem.
The OIG found 55% of behavioral health providers in MA directories were inactive. Cigna settled for $5.7M. CMS created a Special Election Period specifically for members misled by directory errors. Class action litigation is multiplying. Directory accuracy and adequacy compliance are now audit, litigation, and CMS-enforcement categories, with a window closing in 2027.
Continuous, provable accuracy.
30-day update windows on every directory change. Annual attestation of accuracy to CMS. Network adequacy submissions to state DOIs. Provider records reconciled against NPPES, licensing, and claims activity. And a paper trail that survives discovery.
A quarterly snapshot.
Credentialing data that lags by weeks. A provider data management system that tells you who you think is in-network, not who's actually seeing patients. Adequacy checks run before HSD submission and then forgotten, until CMS flags a county.
Four monitors for the audit era.
The same CMS-methodology engine that powers every Radius view, tuned for the day-to-day compliance workflow. API-accessible, priced for continuous use, accurate to the same standard CMS will apply at ACC.
Which listings are actually real?
Continuous validation of every provider record against NPPES, state licensing boards, and claims-verified activity. Phantom listings, stale specialties, and closed-panel providers are flagged before CMS or OIG finds them.
Where will you fail, before CMS tells you?
Monthly T&D re-runs across your network, projected against provider churn, terminations, and retirements. See counties trending toward failure three quarters ahead of the ACC check, with enough runway to actually recruit.
Where should recruitment dollars go first?
Every adequacy gap in your network, ranked by member impact, recruitment feasibility, and regulatory sensitivity. The list your VP of Network Development works from, not the list CMS hands you after a failure.
Evidence, on 24 hours' notice.
Attestation packets, 30-day update logs, and accuracy metrics formatted for CMS HPMS, state DOI submissions, and OIG inquiries. Every figure traceable to the raw data and timestamp behind it.
Compliance monitoring on a production API.
The legacy adequacy stack runs overnight, outputs spreadsheets, and bills as an annual license. That's the wrong cadence for 30-day update mandates, the wrong format for a compliance dashboard, and the wrong price point for a capability your network ops team needs to run continuously.
Radius exposes the same CMS-methodology engine as a REST API with typed SDKs. Wire it into your provider data management system, trigger an adequacy re-score on every roster change, and keep the evidence trail generated automatically. Built for the operating tempo the 2027 mandates actually require.
The same CMS methodology, pointed at your own network.
We compute time-and-distance adequacy the same way Quest does for the MA Automated Criteria Check, so the results you see now are the results CMS will see at submission.
Your HSD & directory, ingested.
Provider records, NPI-level specialty taxonomy, service locations, and your submitted or draft HSD tables, loaded nightly via secure SFTP or API.
Cross-validated against the ground truth.
NPPES, state medical boards, and optional claims activity feeds reconcile each listing. Phantom and inactive providers are flagged with the evidence attached.
T&D run at CMS parity.
Best-in-class drive-time routing fed into a purpose-built geospatial engine, the same county/specialty math Quest uses for ACC, producible under audit.
Compliance, surfaced.
Accuracy metrics, adequacy scores, gap priorities, and attestation-ready outputs routed to your compliance and network ops dashboards, with raw-data lineage preserved.
Built for the team on the hook at the next audit.
Director of Network Operations. VP of Compliance. Director of Provider Data. The counsel reviewing the class-action complaint. The executive whose name goes on the annual attestation.
Medicare Advantage plans
MA / MAPD carriers facing the 2027 Plan Finder directory mandate, 30-day update windows, and CMS ACC exposure. The enforcement category with the sharpest teeth.
QHP issuers in ACA marketplaces
State-Based Marketplace issuers in states implementing quantitative T&D standards under the 2027 NBPP devolution. Adequacy submissions become state DOI filings, with multi-state carriers facing 20+ different review regimes instead of one federal one. The category most exposed to the post-devolution patchwork.
Medicaid managed care organizations
MCOs with state DOI adequacy oversight and active compliance pressure. The population with the least tolerance for directory failure.
Three enforcement vectors are converging, on you.
Directory accuracy and network adequacy were historically self-reported and rarely examined. That model is finished.
ACA NBPP devolution
NBPP devolves ACA network adequacy to the states. Every state DOI you file in is building its own Effective Review Program. Multi-state QHP issuers face 20+ different review postures instead of one federal one, on rolling SBM implementation timelines.
MA directory mandate
CMS Medicare Plan Finder integration. 30-day update requirement. Annual accuracy attestation. Misleading listings trigger the member Special Election Period, a retention problem, not just a compliance one.
OIG & litigation
Cigna $5.7M directory accuracy settlement. OIG audit cycle escalating. Class actions across MA and ACA marketplaces multiplying. Every directory error is now discoverable evidence, not a provider data management annoyance.
Run your next attestation with evidence.
90-day audit-readiness assessments are open for MA plans, QHP issuers, and Medicaid MCOs. We'll score your current directory and adequacy posture against the 2027 enforcement standard, and hand you the gap list.