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State Efforts to Coordinate Provider Directory Accuracy

Publication Date
Stephanie Kissam, Michele Dorsainvil, Keegan Barnes, John Feher III

Provider directories are lists of in-network providers produced by health care plans. They are an important tool for individuals seeking health care providers, and for regulators who monitor the adequacy of health plans’ provider networks. Inaccurate provider directories make it difficult for patients, particularly those seeking behavioral health-related care, to locate and access care and may result in unexpected out-of-network fees. This study focused on how states may coordinate one type of solution to improve accuracy: a centralized provider directory. To learn from states’ experiences with centralized provider directories, the study team conducted an environmental scan of peer-reviewed journal articles, other reports published by governmental and private entities, and government and industry websites; interviewed key informants; and developed case studies of two states with contrasting experiences: California, which has an operational centralized provider directory, and Michigan, which has a centralized provider directory that supports other core functions involved with electronic health information exchange, but is not used by health plans to manage provider information in consumer-facing directories.

This research was conducted under contract #HHSP233201500039I between HHS/ASPE’s Office of Behavioral Health, Disability, and Aging Policy (BHDAP) and Research Triangle Institute. Additional research in this area is available at the ASPE Behavioral Health page.

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