How H1 Helps Health Plans Meet the REAL Health Providers Act and Beyond

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As the spotlight intensifies on health plans, pressure to ensure provider directory accuracy is mounting. The REAL Health Providers Act (H.R. 5281, 119th Congress) sets a new standard: annual accuracy analyses, public accuracy scores, and consumer protections against “ghost networks.” Old processes won’t cut it. You need partners with deep data expertise to not just comply, but lead. Turning these new regulations into growth drivers as opposed to challenges.

Meeting the REAL Health Providers Act Requirements Today

The Act requires Medicare Advantage plans to conduct annual provider directory accuracy analyses using HHS-specified methods and calculate a public accuracy score.

Compliance requirements take effect in plan year 2028, with public accuracy scores following in 2029. Plans must prominently display their accuracy scores in directories, with HHS publishing scores on a CMS website in machine-readable form. Non-compliance risks penalties, reputational damage, and member churn.

Public visibility will shift market share toward plans that prioritize accuracy. H1 tackles messy data sources, siloed inputs, and team disconnects head-on as the only platform unifying experience, depth, and sophistication.

How H1 Makes Compliance Automatic

H1 transforms regulatory burdens into advantages with purpose-built tools:

  • Roster Automation for continuous verification: Ingests hundreds of rosters, claims, and feeds into one normalized source of truth. Automatically verifies network status, patient acceptance, and contact info—meeting 90-day cadences without manual effort.
  • AI-powered confidence scoring (90%+ accuracy): Assigns CMS-aligned scores to every data point. A typical NPI-address-phone record jumps from 59% to 90%+ confidence, providing defensible evidence for your accuracy score.
  • Network Universe for adequacy proof: Links accuracy to network design and geographic access. Proves compliance by specialty and location with audit-ready reports.
  • Directory Stream for ongoing enrichment: Continuously adds attributes like languages, telehealth, and specialties to keep directories current.

From Compliance to Competitive Edge

Using H1, compliance teams get accuracy scores and reports ready for HHS submission. Network teams eliminate ghost providers and prove adequacy. Member experience improves as patients find real, available in-network doctors.

The result: Meet REAL Act requirements today, not 2029. Higher accuracy scores, happier members, proven compliance.

Request a demo to see how H1 improves provider data accuracy and helps you meet compliance requirements.