Free Network Build Assessment
Take it freeBlueprint is the CRM built for health plan provider network teams. Pipeline management, LOI tracking, credentialing workflows, and campaign outreach — all in one place. As your team works the build, adequacy scoring updates automatically in the background.
Used by Medicare Advantage, Medicaid, Exchange/QHP, and D-SNP teams
You don't find out you have a gap until it's expensive to fix.
With 22 HSD specialty types across dozens of counties, one missing provider in one category can fail your entire submission. Spreadsheets don't tell you where you stand.
Most teams discover adequacy gaps in the final 3 weeks before deadline — when emergency contracting is the only option and costs double.
Provider status in email threads. LOI tracking in one spreadsheet. Credentialing in another. No one has the full picture, and no one can answer “are we adequate?” in real time.
The Guide
Blueprint gives your team one place to manage the entire build. The pipeline, the campaigns, the credentialing, the outreach — all running in one system, with your full roster visible at a glance. No spreadsheets. No email threads. No guessing.
And as your team works the pipeline — moving providers from Outreach to LOI Signed to Contracted — Blueprint Analytics scores your adequacy automatically. You don't run a separate report. The score just updates.
Step 1 of 3
Every action your team takes in Blueprint CRM — contracting a provider, advancing an LOI, clearing credentialing — instantly updates your county adequacy score in Blueprint Analytics. You're not reconciling two systems. They share a single data layer, so the score updates as you work.
| Specialty | Maricopa | Pima | Pinal | Coconino | Cochise |
|---|---|---|---|---|---|
| Cardiology | ✓ | ✓ | ⚠ | ✗ | ✗ |
| Primary Care | ✓ | ✓ | ✓ | ⚠ | ⚠ |
| Oncology | ✓ | ✓ | ✗ | ✗ | ✗ |
| Behavioral Health | ✓ | ✓ | ⚠ | ⚠ | ✗ |
| Nephrology | ✓ | ✓ | ✓ | ✗ | ✗ |
| OB/GYN | ✓ | ✓ | ⚠ | ✗ | ✗ |
Step 2 of 3
Every provider you contract updates your score. Every county turns from red to green. You see exactly what you need to close — weeks before deadline, not days.
Blueprint's adequacy scoring is built on the same data CMS and state agencies use to evaluate submissions. Here's exactly what powers it.
For Medicare Advantage builds, Blueprint pulls directly from CMS's official Health Service Delivery (HSD) Reference File — the same document CMS uses to evaluate your submission. It defines all 22 specialty categories, time-distance thresholds by county, and the minimum provider-to-member ratios for every service area.
For Medicaid MCO and Exchange/QHP builds, Blueprint maintains state-specific adequacy standards sourced from each state's managed care regulations, SERFF filings, and state contract templates. Rules vary by LOB, waiver type (e.g. LTSS, D-SNP alignment), and county urbanicity classification. We track rule changes quarterly.
Blueprint matches each provider's primary practice address to their service counties using NPI registry data and CMS county FIPS codes. Time-distance is calculated from the provider's practice location to the county population centroid and compared against CMS thresholds — the same methodology CMS uses to evaluate HSD submissions.
Every time your team moves a provider through a pipeline stage — from LOI Sent to LOI Signed, or from Credentialing to Contracted — Blueprint immediately re-scores every county that provider serves. You are never looking at stale data. The score on screen is always current.
Methodology
Blueprint's scoring is aligned with CMS's published HSD evaluation criteria and has supported first-submission approvals across Medicare Advantage, Medicaid, Exchange/QHP, and D-SNP builds.
We don't invent our own standards. We encode the rules regulators already use — so the score you see in Blueprint is the score CMS and your state agency will apply to your submission. What you see is what they see.
Step 3 of 3
Blueprint's outreach campaigns let you contact multiple providers at once, track every response, and see your adequacy score update as each LOI converts.
Upload your provider list from NPPES or CSV. Blueprint maps each provider to their counties and specialties automatically.
Your starting adequacy score runs on day 1. You see every gap by county and specialty type immediately.
Blueprint ranks your gaps by severity and shows you exactly which providers to recruit first for maximum adequacy impact.
Launch campaigns to target providers across gap counties. Track LOI status, credentialing progress, and notes in one place.
Export your HSD tables, adequacy certification, and good-faith documentation. File with confidence.
The cost of late gap discovery isn't just embarrassing. It's expensive.
Providers contracted in the final 2 weeks typically cost 30–40% more. You're negotiating from desperation, not strategy.
A single unclosed gap can trigger a deficiency notice — delaying your approval, flagging your plan for additional review, and damaging your CMS relationship.
Without a documented build process and audit trail, next year's build starts at zero. Same counties, same gaps, same panic.
Blueprint teams file with confidence.
Illustrative scenarios based on common network-build situations — not actual customers. Blueprint is a new product.
“Continuous scoring gives a real-time view of the adequacy gap, while there's still time to act.”See the scenario
“State-specific Medicaid rules are built in, so the team isn't reverse-engineering requirements late in the timeline.”See the scenario
“When chronic shortage counties recur, the gap is usually documentation — Blueprint captures the good-faith record CMS expects.”See the scenario
Your team is live in 3 days. Your pipeline is running. Your adequacy score updates automatically as you work.