Directory accuracy is now a law with a 90-day clock
Your roster inbox wasn't built for this: every provider re-verified every 90 days, every update live within 2 business days — and every entry a member relies on is honored at your expense if it's wrong. The team can't call its way through the backlog, and 2–3% of records go stale every month whether anyone touches them or not.
What does the No Surprises Act require of provider directories?
The No Surprises Act requires health plans to verify each provider's directory information at least every 90 days, process submitted updates within 2 business days, and honor in-network cost sharing whenever a member reasonably relied on inaccurate directory data — the plan absorbs the difference.
That turns directory accuracy from a customer-service metric into an operational obligation with an uncapped financial tail. Underneath it is a master data management problem: the same clinician arrives from three sources in three formats, and something has to decide which version is true.
Ghost networks made this a law — and the decay never stops
Directories full of clinicians who had moved, retired, or never accepted the plan became a national story, and regulators responded with clocks and liability. The operational problem is that provider data decays continuously.
Roughly 2–3% of provider records change every month. Left alone, a directory drifts materially out of date within a year — which is why accuracy has to run as an operation rather than an annual clean-up project. Each entry a member acts on and finds wrong can cost more than a month of running the pipeline properly.
The directory symptoms every network team recognizes
What a compliant directory operation looks like
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1
Ingest group rosters, credentialing records, and commercial reference data plus the NPPES national registry
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2
Normalize every source into one schema — addresses, specialties, panel status, languages
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3
Match on National Provider Identifier plus fuzzy name and address comparison, so one clinician is one record
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4
Apply survivorship rules that decide which source wins per field, with the decision recorded
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5
Publish the golden record to the member-facing directory inside the 2-business-day window
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Run the 90-day attestation clock per provider, with aging, escalation, and an auditable trail
The audit measures how many records are past their 90-day clock, how long updates actually take to publish, and where your sources disagree — the evidence you need before a regulator asks.
What good looks like — and where it's already running
Results from Artha's anchor engagement at one of the largest Blue Cross Blue Shield plans. Presented as capability proof from a single client — not industry averages.
Provider directory compliance, answered
Health plans must verify each provider's directory information at least every 90 days, process submitted updates within 2 business days, and honor in-network cost sharing when a member reasonably relied on inaccurate directory information — the plan absorbs the difference.
A published provider directory populated with clinicians who have moved, retired, closed their panels, or never accepted the plan. Members cannot actually get appointments, which drew regulatory action and made directory accuracy a legal obligation rather than a service issue.
Roughly 2 to 3% of provider records change every month as clinicians move, join new groups, or close panels. An untouched directory drifts materially out of date within a year, which is why accuracy has to be an operation rather than a periodic clean-up project.
Yes. The pipeline runs on the credentialing system you already own — Artha ingests rosters, credentialing records, and reference data, resolves them into one golden record per provider, and publishes back through your existing directory workflow.
Scorecards and audit feeds measure the problem. They do not wire the feeds into your systems, resolve conflicting sources, run the 90-day attestation cycle, or publish inside the 2-business-day window. That operational work is what closes the compliance gap.
Recognizing that the same clinician appears differently across sources — a group roster, a credentialing record, and a national registry entry — and merging them using the National Provider Identifier, fuzzy name and address matching, and survivorship rules that decide which source wins per field.
The 90-day clock is already running
Find out where your directory actually stands — before a member relies on the wrong entry.
