The Overlooked Bottleneck of Provider Data Accuracy
Accuracy failures rarely originate where teams look for them. They begin at provider roster ingestion, where inconsistent formats, missing fields, and incorrect data quietly introduce downstream risk. Getting ingestion right creates cleaner data, faster issue detection, and scalable accuracy.
Accuracy takes shape long before validation at a health plan begins. When unreliable provider data enters a system, downstream workflows become reactive, burdening provider network management teams with manual fixes and operational friction. This dynamic becomes most visible at the point of provider roster ingestion. How provider data enters the system impacts how effective accuracy efforts can be later on. When ingestion is structured with accuracy built in, health plans are able to review rosters more effectively and surface issues back to providers early before errors propagate downstream.
The Reality of Provider Rosters
Health plans receive provider rosters from health systems, clinics, and delegated groups on a regular cadence. These rosters arrive in many formats, such as Excel files and PDFs. These formats may work for senders, but they often don't meet the needs of health plans or their members.
A typical roster includes provider names, specialties, and locations, but formatting varies widely. Often essential fields like National Provider Identifiers (NPIs) and address components are missing or incomplete. Before validation can occur, provider network operations teams must interpret what they received and map it into an internal data model. This preparatory work is manual and time-consuming, and it introduces variability, as each roster demands a different approach that increases the likelihood of inconsistent records across systems.
The challenge grows when updates arrive outside formal workflows, such as receiving a provider’s location change in a one-off email or a corrected specialty updated in a separate file. Without a consistent ingestion process, teams apply these changes unevenly, creating conflicting versions of the same provider record. In contrast, a well-governed ingestion process allows health plans to quickly identify discrepancies and relay them back to providers so issues can be corrected at the source.
Why Unreliable Inputs Undermine Accuracy Efforts
Fragmented provider roster ingestion undermines data accuracy and places a heavy burden on network operations teams. A CMS review found that more than half of Medicare Advantage provider directory locations contained inaccuracies, such as incorrect contact information or providers incorrectly listed as accepting new patients.
The impact extends beyond compliance. Conflicting records erode internal trust and increase manual work, while members feel the effects directly. A 2025 consumer survey showed that one third of users encountered incorrect provider information, and CAQH estimates that 20%–30% of provider records change each year, making inconsistent ingestion a compounding risk.
How Health Plans Are Rethinking Roster Ingestion
Many organizations view provider data accuracy as something that happens after data enters their system. In reality, reliable data starts with how information is ingested. Effective ingestion must do more than accept files or attachments. It must interpret dozens of structures, map disparate fields to a consistent internal model, and ensure required information exists before records move forward. Otherwise, provider operations teams inherit variability that no amount of downstream validation can fully fix. When accuracy is embedded at ingestion, health plans regain control by creating a feedback loop that flags issues early and enables faster resolution with providers.
As regulatory expectations rise and provider networks grow more complex, some health plans are rethinking how roster ingestion fits into their provider data strategy. Rather than treating ingestion as a clerical task, they are investing in infrastructure built to absorb variability by default.
Modern ingestion approaches account for several realities: provider rosters will continue to arrive in different formats, updates will not follow a clean cadence, and source data will remain imperfect. Systems must absorb this variability without creating manual work at every step.
Candor Health has focused on treating this ingestion layer as foundational. By automatically identifying fields across roster formats, enriching missing attributes such as NPIs or address components, and consolidating fragmented updates into a single standardized output, Candor addresses root causes of downstream accuracy challenges.
To support ongoing data quality, Candor’s approach also:
Provides detailed accuracy reporting and tracks attribute-level changes over time
Auto-fills missing fields such as NPIs and TINs
Accepts rosters of any type or format
Processes thousands of provider records in minutes
This approach does not replace governance or validation, but it makes those efforts effective. When data enters the system in a consistent structure, accuracy workflows become repeatable and scalable. Issues can be identified and communicated back to providers almost immediately, allowing corrections to happen at the source rather than through repeated internal remediation.
What Changes When Ingestion Works
When roster ingestion works, the effects extend across provider data operations. Accuracy teams spend less time normalizing data and more time validating it, updates move through systems predictably, and internal stakeholders gain confidence in provider records.
One health plan that partners with Candor previously spent two to three hours manually formatting large roster files before their internal systems could ingest them. With automated ingestion in place, that same process now takes no more than five minutes. The result is meaningful time savings for network operations teams and a reduced cost of maintaining accurate provider data.
Operational efficiency improves as rework declines, data governance becomes easier to enforce when records follow consistent rules from the start, and member-facing directories reflect fewer discrepancies and more timely updates that support both compliance requirements and trust.
Most importantly, ingestion becomes a control point rather than a liability. Health plans gain visibility into what enters their systems and confidence in how it is handled, and accuracy shifts from remediation to prevention, starting at intake rather than downstream cleanup. By pairing structured ingestion with timely provider feedback, health plans move from reacting to data issues to actively controlling them.
Learn more about how Candor Health helps health plans bring order to provider roster ingestion and build accuracy into provider data from the start.
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