Provider Network Integrity: A Data Intelligence Report Written By Cristina Stahr Share this Provider directories matter because members rely on them. When a health plan member searches for an in-network doctor, they’re trusting that the listing is current, that the provider is licensed, and that nothing disqualifies them from providing care. Federal and state rules require payers to keep these directories accurate and publish them through public APIs. This report is a joint project between ProviderTrust and Defacto Health, building on Defacto’s annual State of Provider Networks report. Defacto supplied data spanning 144 payer directories, covering every payer category it tracks. ProviderTrust ran that data through its verified provider data platform, checking provider records against primary sources, including federal and state exclusion lists, licensing boards, controlled substance registries, and board certification bodies. The goal was straightforward: take the data payers already publish and see whether it holds up relative to the expectation that providers are qualified to be in-network. It largely does not.See The Full Report
