Most practices think credentialing ends when an approval letter arrives. A provider is enrolled, contracted, and marked active. From there, billing should follow.
In reality, that’s often where problems begin.
Provider directory accuracy has quietly become a critical dependency across healthcare operations. What started as a consumer-facing “find a provider” tool is now deeply connected to eligibility checks, prior authorizations, and claims processing. A provider can be fully credentialed and still experience denials, access issues, or payment delays if directory data is inaccurate or out of sync.
As payors rely more heavily on automation and tighter verification standards, directory accuracy is no longer a secondary concern. It is part of staying billable.
What provider directory accuracy actually means
Provider directories contain more than names and phone numbers. They reflect how payors recognize providers across multiple systems. Typical directory data includes provider name and NPI, practice locations, specialties and taxonomy codes, network participation status, accepting new patients indicators, and contact information.
This information is sourced from multiple systems, including CAQH, the NPI registry, credentialing applications, roster submissions, and periodic attestations required by payors and accrediting bodies.
Problems arise when those systems fall out of alignment.
Nothing may have changed at the practice, but a directory can still become inaccurate if one system updates while another does not. Automated payor systems do not reconcile discrepancies. They flag them.
Industry research consistently shows how common this problem is. Joint work by the American Medical Association and CAQH has found that 40 to 50 percent of provider directory listings contain at least one inaccuracy, most often related to address, specialty, or network status.
The legal framework and where confusion starts
Provider directory accuracy is governed by federal and state law. Under the Affordable Care Act, CMS regulations for Medicare Advantage and Medicaid managed care, and the No Surprises Act, health plans are legally required to maintain accurate, up-to-date provider directories.
CMS requires Medicare Advantage and Medicaid managed care plans to verify directory information at least every 90 days. NCQA accreditation standards further require ongoing monitoring and verification of provider data.
That responsibility sits with the payor, not the provider.
However, payors are permitted to rely on provider-supplied data and verification responses. When information is inaccurate or unverified, plans may mark data as unreliable, suppress listings, or update participation status until confirmation is received.
Legally, the plan carries the compliance obligation. Operationally, the consequences are often felt by the practice.
How inaccurate directory data affects providers in practice
When directory data is wrong or unverified, providers experience problems that feel disconnected from credentialing.
Claims deny or route for manual review. Prior authorizations misroute or fail. Eligibility systems treat the provider as out of network. Providers are marked as not accepting new patients. Patients are told the provider is inactive or unavailable.
These issues can occur even when contracts are signed and enrollment approvals are complete. From the practice’s perspective, it feels arbitrary. From the system’s perspective, it is a data alignment failure.
Where directory accuracy breaks down most often
Certain data points cause problems far more frequently than others.
Addresses are the most common issue. Small differences such as suite numbers, abbreviations, or legacy locations can trigger mismatches across CAQH, NPI records, and payor systems.
Specialty and taxonomy errors are also common. Directories may list a general taxonomy when a provider bills under a subspecialty, leading to authorization and claims routing issues.
Network and location linking failures occur when a provider is approved but not properly associated with the correct group contract, location, or delegated network.
Provider status errors appear when new providers show as inactive or terminated providers remain active.
Accepting new patients indicators often default incorrectly when verification requests are missed, quietly limiting access.
Do providers know this is their responsibility
Often, no.
Many providers assume credentialing approval means the work is finished. Directory verification requests are easy to overlook and often arrive as administrative emails sent to outdated inboxes or former staff.
Practices usually become aware of directory problems only after something breaks, when claims deny, authorizations stall, or patients report conflicting information from the payor.
Who manages directory accuracy and where it falls apart
Responsibility varies widely across practices.
Some manage updates internally, often inconsistently. Some credentialers include ongoing directory maintenance. Many credentialing engagements end at approval.
When directory management is not explicitly owned, it becomes no one’s job. Verification requests are missed. Updates lag behind staffing changes. Problems surface months later, disconnected from their original cause.
How often verification requests are sent and missed
Verification frequency has increased across payors.
Medicare Advantage and Medicaid managed care plans commonly verify quarterly. Commercial plans verify quarterly or semi-annually. Some plans now perform monthly checks on key data points to meet CMS and NCQA standards.
When providers do not respond, plans may mark information as unverified, suppress directory listings, or update participation status. These actions are permitted under CMS regulations and are increasingly automated.
What practices can control and what they cannot
Practices cannot control payor review cycles or directory refresh timing. They cannot override automated eligibility or authorization systems.
They can control data consistency across CAQH, NPI records, licenses, and rosters. They can assign clear ownership of directory maintenance. They can monitor and respond to verification requests. They can proactively review directory listings.
The largest preventable issues stem from inconsistent setup and unclear ownership, not payor behavior.
Preparing for 2026
As verification standards tighten and automation increases, directory accuracy will matter more, not less.
Practices preparing for 2026 should assign responsibility for directory maintenance, ensure provider data aligns across systems, confirm how credentialing support is scoped, and track verification requests centrally.
Credentialing approval is necessary. Accuracy is what keeps providers visible, accessible, and billable.
One final insight
Directory issues are easier to prevent than to diagnose. Once they affect billing or access, identifying the cause and correcting it can take months.
That’s why directory accuracy needs ownership, even when everything appears to be working.
