Why is provider directory accuracy critical and how is it maintained?

• A. Ensures members can find in-network care; maintained through CMS/plan updates and regular verification.
• B. Only affects provider scheduling.
• C. Primarily used for marketing materials.
• D. Is updated once a year.

Answer: (A)

Provider directory accuracy matters because members rely on this directory to locate in-network care that matches their plan and is reachable at the right location and time. When the directory has outdated or incorrect entries, members may face out-of-network charges, provider unavailability, or delays in treatment, which undermines access and costs. The best approach to keep it accurate combines CMS and plan updates with regular verification. CMS and the plan periodically refresh network data to reflect provider affiliations, locations, hours, and status, while ongoing verification checks entries through provider outreach, automated data feeds, and audits to catch changes between updates. This continuous maintenance ensures members can trust the directory, supports network adequacy and proper cost sharing, and helps with compliance. It isn’t about scheduling alone, marketing materials, or a once-a-year refresh, because those scenarios don’t provide the timely, accurate information patients rely on.