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Provider Directory Data Accuracy Audit
Every directory attribute compared across every source that publishes it, with the discrepancies flagged and every correction logged with the date it went out.
River's provider data and directory accuracy tool lines the same provider up across every source that publishes them. CAQH, each payer's directory, your own website, your enrollment records, the state license record. Then it compares them attribute by attribute: name and group, address, phone, website, specialty, whether new patients are being taken. Every disagreement gets flagged with which sources disagree and what each one says. The output is a matrix, and below it, the corrections to send per source.
Search this and you get explainers on what the rules require, plus vendors that push your data out to payers. Neither compares sources against each other. A vendor syncing a profile outward cannot tell you that your own website says one suite number and CAQH says another, because your website is not something it reads. That mismatch is what misdirects patients, and a specialty that disagrees between two sources is what quietly stalls an application.
The second artifact is a dated log, and it is the one that settles arguments. A plan's clock to update its directory starts when it receives your information, so what you submitted and when is the only thing that puts a stale listing on their side of the line. Most practices cannot produce that record. Where the delay sits in the application rather than the directory, a stage by stage credentialing review is the next place to look. Where wrong data has already reached claims, a denial root cause analysis traces it back.
Four events that oblige you to submit
Most coverage of this frames directory accuracy as the plan's problem. Federal law puts a piece of it squarely on the provider. Since January 2022 each provider and facility must have business processes to ensure timely provision of directory information. The statute names four submission points: when a network agreement begins, when it ends, when the content materially changes, and whenever else is appropriate. Four named events, and almost nobody tracks them as events.
The attribute list is not a matter of taste either. Medicaid managed care directories must carry name and group affiliation, street address, telephone, website, specialty, whether new enrollees are accepted, language capability, physical accessibility and telehealth. The electronic directory then has to be updated within 30 days of the plan receiving your update. Marketplace issuers owe an up-to-date, accurate and complete directory covering location, contact, specialty, medical group and institutional affiliations. Receiving is the trigger, which makes your submission date the evidence.
Kilbride Medical Group checked 34 providers on nine directory attributes across six sources. It found 214 discrepancies: 71 in phone or website, 61 in address, 44 in specialty, 38 in whether the provider was accepting new patients. Seven of the specialty mismatches sat on applications already in flight, and three of those had been open past 90 days. All 214 corrections went out dated. Of them, 129 appeared in the payer directory inside 30 days and 85 did not.
How it works
Send the sources
CAQH exports, payer directory listings, your website pages, and the enrollment records you filed.
Read the matrix
One row per provider and attribute, one column per source, with every disagreement marked.
Send the corrections
Per source, in the order that unsticks an application before it fixes a phone number.
Log the date
What went where, and when. That date is what the plan's own clock runs from.
What you get
- Every provider compared across CAQH, each payer directory, your website and your enrollment records
- The nine attributes the regulations actually name, not whichever ones your vendor syncs
- Discrepancies flagged per attribute, showing which source says what, side by side
- Corrections written per source, in the order that clears a stalled application first
- A dated submission log, because the plan's update clock starts when it receives
- The four statutory events that oblige a submission, tracked as events per plan
Common questions
Which sources actually need checking?
Every one that a patient or a payer reads. CAQH, each contracted plan's public directory, your own website, and the enrollment records you filed. Add the state license record and the national provider file if a specialty or taxonomy is in dispute. The point is that the set includes things you control, which vendors skip.
Why does a specialty mismatch stall an application?
Because the reviewer is matching your submission against a profile, and a disagreement is a question they have to resolve before proceeding. It rarely comes back as a denial. It comes back as a request for clarification, or as nothing at all while the file sits. A one word difference can cost weeks.
What has to go in the submission log?
Four fields and no fewer. What you corrected, which source you sent it to, the date, and the confirmation or reference number if one came back. The date is the load-bearing one, because the plan's obligation to update runs from when it received the information, not from when the listing became wrong.
How often should this run?
Quarterly for the full sweep, and immediately on four events: a network agreement starting, one ending, any material change to the data, and a new location or provider. Those four are the ones the statute names, which makes them triggers to act on rather than items on a calendar.
We use a provider data vendor already. What does this add?
The comparison your vendor cannot make. It syncs your profile outward to plans, so it sees one source of truth and pushes it. It does not read your own website, and it does not tell you that two plans publish different suite numbers for the same office. Diffing across sources is a different job from syncing one.
The data is right and the application is still stuck. Now what?
Then the delay is somewhere else, and it is worth finding out where before escalating. Elapsed time by stage tells you whether the weeks went on internal document collection or on the payer's queue, which are two different problems. A stage by stage review is how that gets attributed.
What if a payer directory still shows a provider who left?
That is the termination trigger, and it is the one most often missed. A departure gets handled in payroll and in scheduling and never gets submitted to the plans, so the listing outlives the employment by months. Put it on the same dated log as everything else, with the termination date and the date you told each plan.
Provider Directory Data Accuracy Audit
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