A Leading National Behavioral Health Plan Selects HiLabs to Achieve 'True Network Adequacy' As Ghost Networks Draw Federal Scrutiny

HiLabs, Inc. Deploys MCheck™ NetworkIQ to Transform Paper Compliance into True Network Adequacy — Giving Millions of Members Real Access to Mental Health Care

BETHESDA, Md., April 14, 2026 /PRNewswire/ -- At a moment when federal investigators have found that 55% of behavioral health providers listed in Medicare Advantage directories are inactive^[1], and state regulators are levying multi-million dollar penalties against plans whose networks exist on paper but not in reality, one leading national managed behavioral health organization has moved decisively to close that gap.

HiLabs, Inc., the AI company purpose-built to solve the hardest problems in provider network intelligence, today announced the deployment of its MCheck™ NetworkIQ Platform with a national behavioral health organization serving millions of members. This adds another national health plan to NetworkIQ's growing list of customers, a platform built not to check a compliance box, but to answer the question every health plan CEO should be asking, does their network actually work for their members?

The Network Adequacy Problem CEOs Can No Longer Afford to Ignore

The behavioral health access crisis in America runs deeper than a workforce shortage. At its core, it is a data problem, and it is one that health plans have the power to address.

137 million Americans live in a designated Mental Health Professional Shortage Area, and more than half of U.S. adults with a mental illness received no treatment last year.^[2] These numbers are staggering, but they obscure a more operationally urgent reality: a significant share of the access gap is the direct consequence of health plans operating on provider data they know to be unreliable.

A Senate Finance Committee secret shopper study found that 80% of provider listings across 12 major Medicare Advantage plans were inaccurate or unavailable, with one in three returning a non-working phone number.^[3] Across all plan types, research suggests that 40% to 80% of behavioral health providers listed in directories may be unreachable, not accepting new patients, or no longer participating in the plan's network.^[4]

The industry has a name for this: ghost networks. And regulators are running out of patience with them.

For a health plan CEO, the calculus is now clear: the cost of managing behavioral health networks on stale, manually maintained data is no longer just operational; it is financial, regulatory, and reputational, and the risks are increasing.

Stale directories and lagging roster updates are not merely administrative inconveniences; they are patient safety risks. For a patient in crisis managing schizophrenia, bipolar disorder, or severe substance use disorder, each dead-end call is a barrier that can mean weeks of delayed care, treatment discontinuity, or clinical deterioration. Plans that know who is in their network, where they practice, what care delivery options they offer (in-office, telehealth, or both), and whether they are actively accepting patients are the plans best positioned to deliver on the promise of behavioral health parity. HiLabs built NetworkIQ to be exactly that infrastructure.

"Behavioral health is where the network adequacy problem is most acute — and where the consequences of getting it wrong are most severe. The plans that will lead are the ones that move from directory management to network intelligence. HiLabs exists precisely to enable that shift, and this partnership is proof that forward-looking health plans are recognizing it. We are proud to bring NetworkIQ to bear on one of healthcare's most critical challenges," said Amit Garg, Chief Executive Officer, HiLabs, Inc.

The New Standard for Network Adequacy — And How HiLabs Delivers It

The health plans that will define the next era of behavioral health managed care are not the ones with the largest listed networks. They are the ones who know, in real time, continuously, and with AI-driven precision, exactly what their network can and cannot deliver for a member who needs care today.

HiLabs' MCheck™ NetworkIQ platform was built for exactly this. It replaces the reactive, manual, point-in-time approach to network management with continuous, intelligence-driven oversight across five dimensions that matter to health plan leadership:

• True Network Adequacy, Not Paper Adequacy: NetworkIQ continuously validates which providers in a plan's directory are genuinely active, reachable, and accepting new patients, eliminating ghost providers before they become regulatory findings, member grievances, or press headlines. Plans on NetworkIQ don't discover access gaps during a CMS audit. They close them before the audit begins.
• Competitive Network Intelligence: Plans don't just need to be compliant. They need to win. NetworkIQ benchmarks network composition against key market competitors, identifying gaps in specialist coverage, geographic penetration, and high-quality provider recruitment, and translates that intelligence into an actionable network development strategy. This is how plans build networks that attract and retain members, not just satisfy regulators.
• Regulatory Readiness at Scale: Automated, continuous tracking of CMS, state, and NCQA network adequacy standards across all lines of business, geographies, and provider types, including the full behavioral health taxonomy and telehealth-eligible providers. Plans can demonstrate compliance with current, validated, actively maintained data. Not a snapshot. Not a quarterly cleanup. A living, auditable record.
• Telehealth as a Core Adequacy Asset, Not an Afterthought: NetworkIQ incorporates virtual providers, including psychiatrists, licensed therapists, and SUD counselors, directly into network adequacy calculations. This gives plans a comprehensive, multi-modal view of what members can actually access. In an era of growing telehealth scrutiny, this is no longer optional.
• Proactive Gap Closure Before Members Feel It: AI-driven detection flags underserved zip codes, provider attrition trends, and contract expiration risks before they result in adequacy violations, out-of-network claims liability, or member complaints. What-if scenario modeling lets plans simulate the impact of provider departures and ghost terminations while prioritizing backfill recruitment before continuity of care is disrupted.

The Window to Act Is Closing

The policy landscape has shifted decisively, and it is not shifting back. In 2025 alone, 29 states enacted 75 bills addressing mental health coverage mandates, parity requirements, and workforce issues.^[5] At the federal level, CMS has sharpened enforcement across Medicare Advantage, Medicaid managed care, and commercial lines of business. NCQA and state insurance commissioners are intensifying parallel scrutiny. Plans are now held to a higher evidentiary bar. They are required to demonstrate not just that time-and-distance thresholds and provider-to-enrollee ratios are met, but that the rosters and directories underlying those calculations are current, validated, and actively maintained.

Telehealth expanded mental health access, but inconsistent coverage policies, cross-state licensure restrictions, and uneven provider participation have limited its impact. Regulators now scrutinize how plans account for telehealth within adequacy demonstrations, requiring real-time rosters of both virtual and in-person providers. This demands directory precision that manual processes cannot deliver. With the behavioral health workforce shortage projected to widen through the decade, plans must demonstrate not just that providers are listed, but that they are reachable and accepting patients.

The convergence of access urgency, regulatory scrutiny, and data complexity has created a clear dividing line in the market. Plans must either invest now in the infrastructure to know, in real time, who is genuinely in their network, or wait until a CMS audit or an attorney general investigation forces the question.

For the millions of Americans who depend on behavioral health networks to access care, including the patient in crisis who makes five unanswered calls and the family navigating a substance use disorder at midnight, this is not an administrative problem. It is a failure of access when it matters most, and one with a proven solution. HiLabs NetworkIQ is that solution. And the plans choosing to deploy it today are the ones that will define what true network adequacy looks like for the decade ahead.

About HiLabs, Inc.

HiLabs, Inc. is a leading healthcare AI company purpose-built to solve the most complex challenges in provider network management. Its flagship MCheck™ Provider Suite is anchored by the NetworkIQ platform, which delivers real-time network adequacy intelligence, compliance automation, and competitive analytics to health plans, managed care organizations, and government programs nationwide. Trusted by leading national and regional plans, HiLabs helps health plan leaders build networks that are not just compliant on paper but genuinely competitive, operationally defensible, and built to deliver for members.

To learn how MCheck™ NetworkIQ can transform your behavioral health network strategy, visit www.hilabs.com or contact us

References

^[1] HHS Office of Inspector General, 'Many Medicare Advantage and Medicaid Managed Care Plans Have Limited Behavioral Health Provider Networks and Inactive Providers' report (October 2025)
^[2] Health Resources and Services Administration (HRSA), 'State of the Behavioral Health Workforce' report (December 2025)
^[3] Senate Finance Committee staff, 'Majority Study Findings: Medicare Advantage Plan Directories Haunted by Ghost Networks' report (May 2023) 
^[4] Neolytix, 'Mental Health Access Crisis US 2025' analysis (January 2026)
^[5] MultiState, 'State Behavioral Health Legislative Trends in 2025' analysis (August 2025)

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SOURCE HiLabs