Researchers Reassess Provider Directory Accuracy: ‘Things Are Actually Pretty Bad’

Apr 07
Apr 07, 2023

As of last year, more than 80% of physicians had inconsistent addresses and specialty information across major health insurance companies’ provider directories, according to a recent JAMA research letter. Neel M. Butala, one of the study’s authors, tells AIS Health the discrepancies can have major implications for patients and payers, including reduced access to care, delayed care and inability to accurately assess physician networks. Regulators also have a difficult time determining whether health insurers meet network adequacy requirements.

Butala adds that he and his coauthors were interested in evaluating provider directories because the No Surprises Act (NSA) includes provisions related to the subject and require insurers to maintain, verify and update their directories. Previously, CMS conducted three rounds of reviews of Medicare Advantage online provider directories, with the last one spanning November 2017 to July 2018 and finding that 48.74% of the provider directory locations listed had at least one inaccuracy. And CMS’s Center for Consumer Information and Insurance Oversight reported similar findings when it compared provider information obtained through secret-shopper calls to machine-readable provider directories in Affordable Care Act marketplace plans for plan years 2017 to 2021.
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Tim Casey

Tim has been a reporter and editor for newspapers, websites and magazines for more than 20 years, including 10 years covering health care business topics. He has a deep knowledge of the managed care industry and pharmacy benefit management. He also has experience covering medical conferences and clinical and legislative health care issues. In 2014, the Society for Advancing Business Editing and Writing selected Tim as one of 15 journalists to participate in a national symposium on the Affordable Care Act. Tim has a B.A. in Psychology from the University of Notre Dame and an M.B.A. from Georgetown University.