Provider Directories Accuracy and Improvement Strategies

This technical report addresses the critical importance of accurate provider directories within the healthcare industry. It outlines the challenges posed by inaccuracies in provider information, such as incorrect addresses and outdated contact details, which can lead to delays in medical care and unexpected costs for patients. The report details federal initiatives, including the No Surprises Act, which mandates that healthcare providers maintain accurate directory information. It also highlights the role of the Centers for Medicare & Medicaid Services (CMS) in conducting audits to assess directory accuracy and the legislative actions taken by various states to enhance provider directory accuracy. Furthermore, the report discusses the methodologies used to measure accuracy, including the National Plan and Provider Enumeration System (NPPES) and secret shopper surveys. The document emphasizes the need for ongoing provider engagement and the establishment of a data quality hierarchy to ensure the reliability of provider directory information.