Conclusion

Provider directories are a public promise. They tell members which providers are available, licensed, and in good standing to provide their care. This analysis of 124 payer directories, spanning 144 blinded networks and a 42-organization segment dataset, shows that promise does not consistently hold up.

The seven findings in this report describe the same problem from different angles. Exclusions, expired licenses, lapsed registrations, and stale certifications appear across nearly every network examined, regardless of size or payer category. The pattern is not concentrated among a few poorly run plans. It is close to universal and driven less by misconduct than by manual administrative processes between credentialing cycles.

The path forward is not complicated in concept, even if it takes real work to execute. Directories built on primary source data, checked continuously rather than periodically, are more likely to reflect who is available and qualified to see patients. That is the standard the industry should be working toward.