Provider Directory

A searchable listing of all healthcare providers in a payer's network, used by members to find in-network providers in their area.

The provider directory is the public-facing list of all credentialed, participating providers in a payer's network. When a member needs to find a doctor, they search the provider directory on the payer's website or app. If you are not in the directory, patients cannot find you through their insurance. Getting listed accurately in the provider directory is one of the most overlooked parts of credentialing. After you are credentialed and your contract is signed, the payer loads your information into their directory. This includes your name, specialty, practice locations, phone numbers, office hours, languages spoken, and whether you are accepting new patients. Here is where problems happen: the information in the directory comes from what you provided on your credentialing application and CAQH profile. If your office moved, if you added a new location, if your phone number changed, or if you stopped accepting new patients, the directory will not update automatically. You need to notify the payer and update your CAQH profile. Inaccurate provider directories are a massive issue in healthcare. Studies have found that up to 50% of provider directory entries contain at least one error. CMS and state regulators have been cracking down on this, requiring payers to verify directory accuracy regularly. Some states now fine payers for inaccurate directories. As a provider, you are partly responsible for directory accuracy. Most participation agreements require you to notify the payer of changes within 30 days. If a patient finds you in the directory, calls your listed number, and it is disconnected, that reflects poorly on you and the payer. Check your listing in every payer directory at least once a quarter. Make sure your address, phone, specialty, and new patient status are correct. If you find errors, contact the payer's provider relations department immediately to get them corrected.