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

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.