Medicare Advantage provider directories are riddled with errors. They're not the only ones

Medicare Advantage online provider directories are routinely filled with inaccuracies, according to a recently completed review by CMS.

With 48.7% of provider directory locations containing at least one inaccuracy, the directories have become unreliable. Like many patients, MA enrollees use provider directories to find providers who are in-network. But out-of-date or inaccurate information can leave patients scrambling. 

Although the percentage of directories with at least one inaccuracy has declined slightly from last year, inaccurate directories have been a nagging problem for years. At times, directories said providers were at a different location than they really were. In some cases, they shouldn't have been in the directory at all. Other times, directory listings contained outdated phone numbers or indicated that providers were accepting new patients when they really weren't.

CMS said the weight of these inaccuracies poses a significant access-to-care barrier. According to a survey by the American Medical Association earlier this year, more than half of physicians encounter patients with insurance issues due to inaccurate directories. 

"Beneficiaries and their caregivers rely on provider directories to make informed decisions regarding their health care choices. Inaccurate provider directories can create a barrier to care and raise questions regarding the adequacy and validity of the [Medicare Advantage Organization's] network as a whole," CMS wrote in its report (PDF).

The most common problem in provider directories is listing providers at the wrong location. But CMS also found several other types of inaccuracies.


Medicare Advantage plans aren't alone in this problem; it's also common in provider directories for commercial insurers. The issue is tough to crack because the information is so decentralized. Insurers usually don't track the information for every provider in their network; instead, the providers usually send their data to the insurance company to list.

Insurers spend as much as $2.1 billion in annual administrative costs to maintain the directories, according to CAQH, money that, apparently, isn't well spent. 

That means providers have their information spread out in many different insurers' directories, and if something changes in their practice (like their location or phone number), they have to contact each individual directory to correct it. Since this is a manual process, it's easy for providers to overlook some directories.

CMS recommended that MA plan sponsors look at creating a centralized database they could all use rather than each having their own. That way, changes would only need to be updated in the database once.

"This approach would make data collection and verification more efficient and less burdensome for MAOs and providers, and result in more accurate and timely data sharing," CMS wrote. "For example, when an MAO identifies a directory error, it is fixed only for their own directory, whereas a corrected error in a centralized database would improve directory accuracy for all MAOs using that system. A centralized database, however, will take time and does not obviate the short-term, immediate need of MAOs to improve directories."

Private insurers, meanwhile, are coming at the problem from a different angle. Rather than creating a centralized database, a group called the Synaptic Health Alliance is working on a private blockchain system to allow decentralized databases to update each other.

RELATED: Aetna, Ascension join blockchain alliance targeting provider directories

The group currently includes UnitedHealth, Optum, Humana, Multiplan and Quest Diagnostics, as well as Aetna and Ascension, which joined on Monday. The stakeholders envision a permissioned blockchain that would update all directories in the chain when a trusted partner makes a change.

“Each of our organizations expends a tremendous amount of energy and effort trying to get this data as good as it can be,” Jason O’Meara, senior director of architecture at Quest Diagnostics, told FierceHealthcare in a previous interview. “The challenge is when we’re doing this in independent silos it leads to duplication of efforts.”

However, permissioned blockchains are a fledgling technology, and the connected provider directory itself is something of a proof-of-concept. CMS didn't mention blockchain solutions in its report, instead suggesting that MAOs take a more traditional tactic of performing self-audits and developing better processes for correcting errors.