Provider directory compliance, explained.
Plain-language guides to the No Surprises Act, CMS directory rules, and what an audit actually checks. Written for the people who own the problem.
Automated Provider Attestation in Insurance: A Complete Guide
Automated provider attestation is a software process for asking providers to confirm their own directory listings on the cycle CMS requires.
Automated Provider Outreach Alternatives for Health Plans
Automated provider outreach is a software process that contacts providers on a set schedule to confirm their directory data and network participation.
CMS Provider Directory Audit Preparation: A Complete Guide for Health Plans
A CMS provider directory audit is a review in which CMS checks a plan's published directory against reality, provider by provider.
CMS Provider Directory Update Requirements: The Complete Compliance Guide
The CMS provider directory update requirement is a two-part clock: re-verify every provider at least every 90 days, and post a change within 2 business days.
CMS Star Ratings and Provider Directory Accuracy Explained
Provider directory accuracy is not just a compliance checkbox — it is a direct determinant of CMS Star Ratings performance for Medicare Advantage...
Health Plan Network Accuracy Monitoring: A Complete Guide
Health plan network accuracy monitoring is the ongoing process of checking that a directory matches reality, keeping each provider's details current.
How to Prepare for a CMS Provider Directory Audit
Preparing for a CMS provider directory audit is a matter of evidence: every listed provider reachable, in-network, and re-verified on the 90-day clock.
Inaccurate Provider Directory Solutions for Health Plans
The main reason provider directories are inaccurate is the attestation model, which depends on providers confirming their own listings and reporting changes.
Insurance Provider Directory Compliance Automation Explained
Insurance provider directory compliance automation is the use of software to keep a plan's directory aligned with regulatory rules without manual cycles.
Medicaid Managed Care Provider Directory Requirements: The Complete Compliance Guide
The federal rule for Medicaid managed care provider directories is the standard at 42 CFR 438.10(h): data elements, regular updates, secret-shopper accuracy.
How AI Improves Medical Provider Directory Accuracy
The main reason medical provider directory data is inaccurate is the reliance on attestation; newer methods check each provider against the federal record.
NCQA Provider Directory Standards: Health Plan Accreditation Requirements
NCQA Health Plan Accreditation is not a passive certification — it is an active, surveyed assessment of whether a health plan's operational programs meet...
No Surprises Act Penalties: Provider Directory Compliance Guide
The No Surprises Act penalty for a wrong directory listing is a financial one: the plan owes in-network cost-sharing and the provider refunds overcharges.
Provider Directory Accuracy Penalties: Federal vs. State Rules
The main federal penalty for an inaccurate directory is the No Surprises Act cost-sharing shift; states build their own fines above that federal floor.
Provider Directory Compliance Software for Health Plans
Provider directory compliance software is a tool that helps a health plan keep its directory accurate and meet regulatory update deadlines.
Provider Network Verification Technology: A Complete Guide
Provider network verification technology is a software check on whether a plan's listed providers are reachable and in-network, against primary sources.
The Ghost Provider Problem in Insurance: Causes, Costs, and Detection
A ghost provider is a clinician a health plan lists as in-network who isn't reachable there, not accepting patients, or never contracted at all.
No Surprises Act 90-Day Provider Directory Update: What Health Plans Must Know
The 90-day rule is the No Surprises Act requirement that health plans update provider directories within 90 days of a provider status change notice. Penalties reach $100 per enrollee per day, and members who rely on bad listings keep in-network cost-sharing.