Directory report card
Prioritize the directory updates that matter most
Our insights reveal the directory issues most likely to affect your operations and members' care.Demonstration only. This prototype uses findings from a live provider directory but is meant for illustrative purposes only.
B-Needs attention
Overall assessment
Your directory may send members to a stale location, a provider who no longer practices, or the wrong specialist.
providers likely no longer practice
of subspecialists are under-labeled
Needs attention
Three findings to act on
1
Stale location affiliations
About 13,000 location listings have a high-risk of being stale.
Our stale affiliation risk model identifies provider-location affiliations that are likely wrong. This includes locations that have moved, closed, or where the provider no longer practices, even if they are still active elsewhere.
~13,000high-risk listings~50% chance of being
wrong
wrong
~26,000low-risk listings98% chance of being
accurate
accurate
What can go wrong
Members are referred to the wrong practice, or even one that no longer exists
They face extra calls, longer waits, and a frustrating experience that delays care and erodes trust in the directory and health plan.
Referrals fail and require rerouting
Staff spend time correcting destinations, resubmitting authorizations, and resolving avoidable downstream scheduling and care delays.
2
Out-of-practice providers
About 1,000 providers are likely no longer practicing, or may not even exist as described.
Our stale affiliation risk model identifies provider listings that are likely outdated. This includes deactivated NPIs, providers who are retired or deceased, or listings with no matching provider under the listed name and specialty.
312Deactivated NPIsFrom CMS' NPPES, these NPIs are no longer active.
604Likely retired or deceasedEvidence suggests these providers no longer practice.
91Identity conflictsNo record of a provider under the listed name and specialty.
What can go wrong
Members pursue care that is not available
Calls, appointment requests, and referrals go to a provider who has retired, passed away, or doesn't exist.
Search results create false access
Inactive or invalid providers make the network appear broader than the care members can actually reach.
3
Subspecialty labels
45% of subspecialists are under-labeled in your directory.
Your directory labels do not reliably distinguish subspecialists from generalists across areas such as ophthalmology, orthopedics, and cardiology. Our scope matching model identifies the care providers actually deliver from billing and prescribing behavior, revealing missing subspecialty labels that create avoidable rerouting in both directions.
12,700 of 28,200subspecialists aren't labeled as such.
Subspecialty scope is missing from nearly half of your directory listings.
What can go wrong
Complex cases are sent to the wrong specialist
A generalist may not provide the required subspecialty care, so the member must be rerouted and treatment is delayed.
Routine cases are sent to subspecialists
The subspecialist is inappropriate for routine care, consuming scarce capacity and causing another reroute.