Provider directory
A provider directory is a health plan's list of the doctors, hospitals and other providers in its network, with the details members need to get care: name, specialty, location, phone number, whether they accept new patients and which plans they take.
What does a provider directory include?
Most directories list each provider's name, specialty, practice locations, phone numbers, languages spoken, hospital affiliations, whether they are accepting new patients, and the plans or networks they are part of. Members use it to choose a doctor. Plans also use the same data for referrals, network adequacy reports and claims.
Why are provider directories so often wrong?
Provider details change all the time: doctors move, retire, change groups, stop taking a plan or stop seeing new patients. Most directories are built from what providers report about themselves, through rosters and attestation, and many offices don't report changes promptly. In CMS's 2018 review of Medicare Advantage directories, 48.74% of the provider locations checked had at least one inaccuracy.
What do the rules require?
Since 2022, the No Surprises Act requires group health plans and insurers to verify directory information at least every 90 days and update it within two business days of receiving a change. Medicare Advantage plans have their own directory requirements, and from 2026 CMS shows their directory data in Medicare Plan Finder.