Study Underscores Challenge of Fixing Provider Directory Woes

  • Jul 19, 2024

    A new paper published in BMC Health Services Research by researchers from the University of Colorado found that national provider directories are highly inaccurate — yet another data point confirming payers’ self-described difficulties assembling accurate provider directories. One of the paper’s authors tells AIS Health, a division of MMIT, that he thinks the problem is unlikely to be solved soon. 

    The paper compared providers listed in the online directories of five large insurers (UnitedHealth Group, Elevance Health, Inc., The Cigna Group, CVS Health Corp.’s Aetna, and Humana Inc.) to the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) database — and found that more than 70% of all studied provider data was not consistent across insurers. 

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  • Peter Johnson

    Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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