Automating Provider Directory:

For years, healthcare administrators have grappled with the issues of incomplete, inaccurate, and outdated provider data in managing health plan directories. Without a single trusted source of provider data, health plans must rely on multiple internal and external sources to ensure the integrity and completeness of their directories. 

Facilitating this process, administrators have resigned themselves to the time-consuming and labor-intensive process of contacting providers directly and manually updating listings.

At the point of care, inaccurate directories limit a patient’s access to necessary treatments and services. This can result in surprise billings from the provision of out-of-network care, sometimes even at facilities within one’s own network.

With Medicare and Medicaid Centers, as well as several state legislators, implementing fines for non-compliance, health plan administrators will need to focus more of their human resources on maintaining accurate provider directories.

Increasingly, technological applications and solutions are being developed to reduce the administrative costs and inconvenience of keeping directories up to date, including health plans.

Original release: March 2020

Updated: 6/4/2024 to reflect industry statistics and current legislation.