There is an immediate and continuous path to compliance for Medicaid programs and MCOs.
On April 23, 2026, CMS Administrator Dr. Mehmet Oz sent letters to all 50 governors and every state Medicaid director with two specific demands: notify CMS within 10 days of your intent to conduct swift revalidation of high-risk providers and submit a comprehensive two-year provider revalidation strategy within 30 days.
The mandate was clear and direct. It also laid bare the dirty truth about the condition of healthcare provider data in the United States.
Logical Policy. Chronic Problem.
Requiring state Medicaid programs and their MCO partners to have continuously accurate provider data and visibility into high-risk providers and their behaviors is a good and logical requirement. The reality, however, is that healthcare provider data is chronically inaccurate, dependent on providers to provide the data, and exorbitantly costly to maintain.
According to CMS’ own data, 49% of provider locations have at least one data error 1, and 41.75% of provider locations have data inaccuracies that prevent patient access 2. And JAMA published that 81% of provider data is inaccurate 3. Bottom line, Medicaid has a provider data problem because American healthcare has a provider data problem.
A Permanent Solution Is Already In Use.
The 4L Provider Intelligence solution, powered by patented Integr8 AI™, is already in use monitoring about 250 data elements for each of the 9.1M NPIs in the U.S. today. This solution was developed to overcome the latency, inaccuracy, and expense of provider data systems that are dependent on provider-provided data and require millions of hours annually on manual lookups and phone calls to verify provider data. This data, aside from maintaining continuously compliant provider data, is also essential for dynamic fraud, waste, and abuse prevention.
Accuracy Beyond 2-Year Provider Revalidation Requirements.
The nine (9) requirements in Dr. Oz’s April 23 memorandum are good in a world where provider data is dependent on providers to provide it and where the cost and latency of manual provider verification is acceptable. Compliance with the spirit of the memo means taking the 2-year revalidation requirements and doing better; continuously better. With the 4L Provider Intelligence solution, Medicaid programs and their MCO partners can:
- Monitor network provider data daily across 250 data elements
- Update provider data daily with automated validation across 2 to 3 channels per data element
- Receive near real-time alerts on critical directory and integrity data that impacts patient safety, access, and payment accuracy
- Achieve ‘continuous credentialing’ on all network providers
- Automate provider data updates and actively alert providers to changes in their public data
- Reduce labor and data management costs
- Turn continuously accurate provider data into a revenue-generating fraud, waste, and abuse prevention machine.
Get Compliant Now. Schedule Your 9-Point CMS Provider Revalidation Review.
Contact Fast@4LData.com to schedule your 9-point CMS Revalidation Compliance plan review. A member of the 4L team will help you:
- Assess your current compliance status
- Identify gaps
- Define a path for immediate and continuous compliance
- Reduce overall operating costs.
- Fierce Healthcare / Brian Hoyt / February 11, 2019
- JAMA; January 8, 2023 – Neel M. Butala, MD, MBA
- Association of American Medical Colleges