You Can’t Improve Access to Care Without Fixing Provider Data—Here’s How

Inaccurate provider directories are at the root of one of healthcare’s most frustrating and costly problems. It happens every day across the country: A patient reaches out to a provider that either doesn’t take their insurance, no longer practices at the location listed, or isn’t accepting new patients. These “ghost networks” aren’t just an inconvenience. They’re a source of wasted time, delayed care, lost trust, and billions in avoidable administrative costs. Reports estimate that physician practices collectively spend $2.76 billion annually on directory maintenance.¹ 

Past efforts across the country like state and federal legislation have steered healthcare organizations in the right direction, but the recent RFI from the Centers for Medicare & Medicaid Services (CMS) should serve as a wakeup call to all of us that the industry is still plagued by shared core issues: 

• Misaligned incentives that discourage provider participation 

• Fragmented intake challenges and time-consuming manual workflows  

• Outdated, incomplete, and inconsistent provider data 

And unless something changes, the same issues will continue to persist. Traditional efforts have relied on compliance-driven models that place the responsibility on payers, leaving providers out of the solution and overwhelmed by the process.   

The good news? There’s a better way. Based on Availity’s work with both national and regional health networks and state-wide solutions, we’ve identified four high-impact actions health plans can take right now to simplify provider engagement, reduce friction, and build a more accurate, sustainable provider directory.  

Recommendations for Building Better Provider Directories

Solving the provider data problem starts with simplifying the process and ensuring all stakeholders feel the benefit.  

1. Use Existing Multi-Payer Infrastructure 

Rather than building new, standalone systems, consider tapping into a platform that providers already use. By meeting providers in their existing workflows, health plans can reduce friction, accelerate adoption, and drive greater participation.  

This approach is already delivering results: more than 2.3 million providers actively attest through the Availity portal, demonstrating that when the process is familiar and efficient, providers engage. 

2. Connect Data Submission to Meaningful Results  

Many providers feel that even when they participate in directory updates, their payer partners don’t make the most of the data they provide. Provider engagement rates are more likely to rise when the data they submit is linked to tangible business outcomes like faster, more accurate payments and prior authorization decisions. If providers are taking time to review, attest, and update their record, they should see real value for their effort. 

3. Design for Broader Impact: Enrollment, Credentialing, and More 

Provider data is collected across several touchpoints in the lifecycle of a provider and health plan’s relationship. Similar data elements are collected at the time of enrollment, credentialing, recredentialing, and directory verification – each with an obligation to ‘re-attest’ on a recurring basis. Despite this overlap, few organizations have eliminated the effort duplication on the provider’s part. 

Provider directory data should serve as one part of an integrated system with other workflows that, in turn, require many of the same core data elements. By streamlining, standardizing, and eliminating duplicative data intake and validation processes, organizations can significantly reduce friction across the entire provider lifecycle. 

4. Prioritize the Most Impactful Data Elements First 

Forming the full picture of provider data to serve your entire organization is a journey. We recommend focusing on provider information that: 

• Enables member access to care (location, availability, specialties) 

• Contributes to claim and prior authorization accuracy (NPI, TIN, licensure, billing information etc.) 

• Supports a shift from manual, cyclical enrollment, credentialing, and other provider data exchange events toward continuous, automated verification 

By applying these recommendations, your organization can help break down long-standing barriers to accurate provider data that not only work for your organization and your providers, but, most importantly, your member’s access to timely care.  

With this foundation in place, let’s take a look at a real-world example of how Availity is leveraging these principles within public and private aspects of the California marketplace for meaningful results. 

Real-Word Client Success Story  

One of the strongest examples of this model in action is our role as the sole technology partner with Integrated Healthcare Association (IHA) for Symphony, California’s statewide provider directory utility. Initially developed to support compliance with California State Bill 137, Symphony has evolved into a robust, scalable solution that: 

• Aggregates and harmonizes provider data from 17 of California’s largest health plans by California enrollment and provider organizations representing >100,000 NPIs 

• Uses proprietary algorithms to reconcile 50,000 discrepancies each month across payer, provider, and public datasets 

• Powers the Covered California exchange’s consumer-facing provider directory serving nearly 2 million consumers 

Today, Symphony offers a unified view of over 100,000 individual providers and more than 700,000 provider-location-network combinations. This demonstrates that when stakeholders align around a shared data model, directory accuracy, consumer transparency, and administrative efficiency can all be achieved, at scale.  

The Path Forward: Shared Data, Shared Success 

At Availity, we believe a central store of provider data can establish a single source of shared truth for consumers. This data would drive access to care by matching a patient’s health needs to capable and available providers, all while driving out harmful “ghost networks.”   

Beyond this direct benefit to patients and their caregivers, a single source of truth on provider data would positively impact the entire U.S. healthcare system. With better, up-to-date provider data, nearly every transaction between a patient, provider, and payer becomes more accurate and less administratively burdensome. 

Click the button below to learn more about our approach or to connect with our team to explore what national-scale impact could look like for you.

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About the Author

Curtis Miller is Vice President of Provider Lifecycle Solutions at Availity, where he focuses on reducing friction between payers and providers through smarter use of provider data. He brings a deep customer focus and healthcare expertise shaped by 12 years at Deloitte Consulting, where he led technology-driven transformation for major healthcare organizations. Curtis holds degrees from UNC Chapel Hill and the University of Chicago Booth School of Business. He lives in Charlotte, NC, with his wife and son, and enjoys cycling, photography, and learning French.