For provider-led organizations going payer

You built the care model. We'll carry the payer tech.

Going from ACO REACH or an MSO to your own MA plan is a tech leap — directory, FHIR, adequacy, member search. We run that layer, white-labeled to your plan.

Why now

Going payer means owning CMS's member-facing and interoperability mandates — on top of the care model you already run.

  1. Now

    Submit, update, attest.

    Submit directory data to CMS, update within 30 days of any change, and attest annually that it's accurate.

    42 CFR §422.111(m)

  2. In effect

    90-day verification.

    Verify every provider's directory record at least once every 90 days — required since Jan 2026 (REAL Health Providers Act).

    CMS-4208-F2

  3. PY2027

    Public on Plan Finder.

    Your provider directory goes public on Medicare Plan Finder — accuracy becomes a competitive signal.

    CMS-4208-F2

  4. Jan 2027

    Interoperability APIs.

    Provider Access, Payer-to-Payer, and Prior Authorization APIs come due (the public FHIR Provider Directory API is already required).

    CMS-0057-F

  5. PY2029

    Published accuracy score.

    MA organizations must prominently display their provider-directory accuracy score; CMS publishes it too.

    CMS-4208-F2

The challenge

What's standing in the way.

Clinical strength, payer-tech gap.

You've built a care model that works. The payer-side stack — directory, FHIR, adequacy, member search — is a different discipline CMS still measures you on.

CMS measures the gap, not the intent.

Directory accuracy, FHIR APIs, and adequacy filings are graded the same whether you're a national carrier or a provider group in year one.

Brand and member trust.

Your members should see your name and a polished experience — not a generic vendor tool bolted onto your plan.

Why InsureLytix

Built for exactly this.

01

Stay focused on care.

You built the clinical model; we run the payer-tech and compliance layer behind it, so your team isn't pulled into directory engineering.

02

Proven on the provider-led path.

The same platform already runs a provider-led MA plan in production — this isn't a road we're scouting, it's one we've travelled.

03

White-label, your brand.

Members see your plan — domain, logo, language. We stay invisible; the conformance is ours.

How it works

From your data to live — in about a week.

  1. 1

    Map the leap

    We scope the payer-tech and compliance surface against your launch plan.

  2. 2

    We run the layer

    Directory, search, FHIR, and adequacy analytics — white-labeled to your brand.

  3. 3

    Certify in parallel

    508/ADA, FHIR conformance, and audit logging alongside your build.

  4. 4

    Members see you

    A polished, compliant experience under your name from day one.

Ready when you are

You run the care. We'll run the compliance.

A provider-led MA plan already runs on this in production. We've done this leap before.