Building a Reliable National Provider Directory—Lessons From Other Sectors

Sep 29, 2026

US residents searching for a new health care clinician encounter provider directories that are often inaccurate across insurance markets, geographies, and plans. Evidence cited shows high error rates in Medicare Advantage directories and inconsistency in entries from large national insurers. Causes include rapidly changing, complex data; fragmented maintenance and verification processes; and burdens on insurers and clinicians. Even after regulatory updates requiring more frequent verification, compliance remains limited, suggesting enforcement alone cannot ensure accuracy.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Introduction: inaccurate provider directories

Drivers of directory inaccuracy

Data complexity and fragmented maintenance

Administrative burden on clinicians

Regulatory changes and persistent noncompliance

Divergent purposes: reimbursement vs patient navigation

Data brokers and challenges with proprietary solutions

Author Manuscript Author Manuscript Author Manuscript Author Manuscript | | HHS Public Access
Author manuscript
JAMA Health Forum. Author manuscript; available in PMC 2026 January 06. | | --- | --- | Published in final edited form as: JAMA Health Forum. ; 6(10): e254408 . doi:10.1001/jamahealthforum.2025.4408 . Building a Reliable National Provider Directory—Lessons From Other Sectors Jane M. Zhu, MD, MPP, Michael L. Barnett, MD, MS Division of General Internal Medicine, Oregon Health & Science University, Portland (Zhu); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts (Barnett) . US residents searching for a new health care clinician face a disheartening and onerous experience. In principle, provider directories are an essential tool used by patients to select in-network clinicians and by regulators and policymakers to audit access to care and monitor compliance with network adequacy regulations. However, across insurance markets, geographies, and health plans, provider directories are so highly inaccurate as to render them essentially meaningless. A 2018 report by the Centers for Medicare & Medicaid Services (CMS) found that more than half of clinician listings in Medicare Advantage directories included at least 1 error, 1 matching findings from audits and secret shopper studies.2 A 2023 audit of directories from 5 large national health insurers found inconsistencies in 81% of entries3—a level of inaccuracy consumers would be unlikely to tolerate for any other service or industry. This abysmal state arises from several factors. One challenge is the capricious and complex nature of the underlying data: directory data are akin to a phone book in a town where substantial shares of residents move every month, change their names, and sometimes list their neighbors’ phone numbers instead of their own. Monitoring these shifting data requires substantial time and resources, but because of fragmented data collection, maintenance, and verification processes across stakeholders, there is marked inefficiency and weak incentives to rectify inaccuracies.4 Administrative burdens to maintain data accuracy are borne not only by insurers but also by clinicians who must respond to frequent, redundant reporting requirements. A 2019 survey from the Council for Affordable Quality Healthcare estimated that physician practices collectively spend $2.76 billion annually on directory maintenance alone—equivalent to nearly $1000 per month per practice or 1 full-time staff member per week.5 Practices with fewer resources may lack the capacity to report frequent staffing changes and may be more prone to erroneous data inputs. Open Access: This is an open access article distributed under the terms of the CC-BY License. Corresponding Author: Jane M. Zhu, MD, MPP, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 ([zhujan@ohsu.edu](zhujan@ohsu.edu)). Conflict of Interest Disclosures: Dr Zhu reported receiving grants from the National Institutes of Health (NIH), Agency for Healthcare Research and Quality, and National Institute for Health Care Management Foundation; and personal fees from Cambia Health Solutions. Dr Barnett reported receiving grants from the NIH and Donaghue Foundation and consulting fees from the State of California and Greylock McKinnon Associates. Author Manuscript Author Manuscript Author Manuscript Author Manuscript Zhu and Barnett Page 2 Moreover, regulatory enforcement has been historically weak, although there have been recent efforts to strengthen it. The 2021 Consolidated Appropriations Act specifies that health insurers, both private and public, now hold a default responsibility for maintaining accurate provider directories. All health plans are required to publicly list the clinicians and facilities with which they contract to deliver care to their members. Clinicians and health care facilities are also required to inform health plans of a

FAQs

Why do provider directories fail patients when choosing in-network clinicians?

Directory data across markets and plans can be highly inaccurate, with audit and secret-shopper findings showing frequent errors and inconsistencies in clinician listings.

What factors contribute to unreliable directory information?

The data are complex and constantly changing, while maintenance and verification are fragmented across stakeholders. Administrative burdens also require frequent redundant reporting from insurers and clinicians.

Does strengthening regulation improve directory quality in practice?

Regulation requiring timely updates and verification every 90 days exists, but real-world compliance remains poor, with errors persisting well beyond the required timeframe.

Sep 29, 2026

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