In the increasingly complex U.S. healthcare landscape, accurate provider directories have become essential for patients. These directories play a key role in guiding patients to in-network providers, directly impacting their satisfaction and trust in the healthcare system. Yet despite their importance, healthcare organizations continue to struggle with maintaining up-to-date and reliable provider information. These gaps, once seen as minor inconveniences, have now taken center stage under stricter regulatory oversight, particularly following the passage of the No Surprises Act.
Signed into law in late 2020, the No Surprises Act was designed to protect patients from unexpected medical bills that arise when they unknowingly receive care from out-of-network providers. Among its many provisions, the law specifically requires health plans to maintain accurate, publicly accessible provider directories. It mandates updates at least every 90 days and imposes penalties when patients rely on inaccurate information to select providers. In short, the legislation turned what was once a reputational issue into a legal compliance mandate.
Yet despite the clarity of the law’s intent, meeting these new expectations has proven far from simple.
The Problem
Provider directories often fall victim to a combination of systemic issues: outdated information, poor data management, and a lack of coordination between health plans, third-party administrators, and provider groups themselves. Doctors move, retire, change affiliations, or shift the insurance plans they accept, but these changes are not always communicated efficiently, and even when they are, updating the information across fragmented systems is no easy feat.
The persistence of these inaccuracies is not a small problem. A recent study found that approximately 40% of provider directory entries contained inaccuracies and that these errors could linger for well over a year before being corrected.1 Even more troubling, patients are often the ones who suffer. Misinformation about a provider’s network status can lead to surprise out-of-network charges, exacerbating financial strain and undermining trust in the healthcare system. While many organizations rely on tools like CAQH for credentialing and provider data collection, inconsistencies often arise when this information is not regularly validated or integrated across systems.
These inaccuracies also have downstream effects on claims processing as incorrect provider data can lead to rejected or delayed claims and disputes between providers and payers.
These are not isolated incidents. Based on a survey, 32% of American consumers reported finding incorrect information in their health plan’s provider directory. Of those who encountered errors, more than 80% said it negatively affected their perception of the insurer.2
At a moment when trust is already fragile and healthcare costs are rising, these numbers underscore an urgent need for change.
The Solution
Fixing provider directories is not merely about conducting periodic audits or checking boxes for compliance. It requires a cultural and operational shift in how data is managed across the healthcare ecosystem.
First, organizations must build processes that prioritize continuous verification rather than episodic cleanups. Verifying data once a quarter may meet the letter of the No Surprises Act, but without systems in place to capture changes as they happen, inaccuracies will inevitably creep back in.
Second, better communication between insurers, providers, and third-party data vendors is critical. Far too often, providers are asked to confirm information through labor-intensive processes that are disconnected from their daily operations. Streamlining these touchpoints by embedding update requests into existing workflows, for example, could vastly improve the speed and reliability of information sharing.
Third, and perhaps most crucially, healthcare organizations must invest in interoperable systems. Provider information is frequently siloed across credentialing departments, network management teams, claims systems, and public-facing directories. If these systems cannot "talk" to each other—because the source data itself is flawed—even the most rigorous updates will fail to propagate across the enterprise. Building infrastructure that enables seamless data exchange is fundamental to solving the problem at scale.
Lastly, regulatory bodies themselves have signaled an openness to more collaborative models, suggesting that healthcare organizations that prioritize transparency and proactive management will not just avoid penalties - they will also lead the industry toward a more patient-centered future.
How Mizzeto Can Help
At Mizzeto, we understand that maintaining provider directory accuracy is not simply about compliance; it’s about building systems that support patient trust and operational efficiency.
Our automated solutions are designed to monitor and validate provider information in real time, reducing the risk of outdated entries lingering unnoticed. Rather than relying solely on manual outreach, Mizzeto leverages data-driven methods to flag inconsistencies across systems and suggest proactive corrections.
Recognizing that disconnected systems are at the root of the problem, Mizzeto’s automation-first approach enables seamless integration across data environments. We help unify disparate data sources so that updates in one system are automatically reflected throughout the organization—improving accuracy and reducing administrative burden.
Understanding and demonstrating compliance with the No Surprises Act can be just as challenging as achieving it. Mizzeto helps build custom compliance reports and analytical dashboards tailored to user needs, making it easier for teams to track data updates and stay audit-ready. We also conduct regular data audits to identify gaps and maintain directory accuracy for both internal reviews and regulatory inspections.
Maintaining provider directory accuracy is no longer optional. The stakes—both financial and reputational—are simply too high. The No Surprises Act has raised the bar for what patients and regulators expect, but more importantly, it has created an opportunity for healthcare organizations to fundamentally rethink how they manage one of their most critical assets: information.
Mizzeto stands ready to help organizations meet this moment, offering automation-enabled solutions and hands-on auditing support to build lasting frameworks for success.
1 AJMC