Published, Not Perfect: What’s Lurking in Your Provider Directory?

Health plans are legally required to publish their provider networks via a FHIR-based API — a public statement of who is credentialed, in good standing, and available to serve members. A new industry analysis of these published directories across dozens of payer networks finds that the credentialing and monitoring systems designed to catch problems — excluded providers, inactive or invalid NPIs, expired licenses, lapsed board certifications, and controlled-substance registration issues — are not consistently catching them.

The concern is not hypothetical: a June 2026 HHS Office of Inspector General report found that online Medicaid managed care directories across five states listed out-of-network providers as in-network, omitted in-network providers entirely, and carried inaccurate contact information, gaps OIG tied directly to enrollees’ ability to access maternal healthcare. Even a small number of these gaps in a large network represents meaningful risk to members and compliance exposure for payers, a risk that has only grown sharper since CMS’s April 2026 directive ordering all 50 states to swiftly revalidate high-risk Medicaid providers.

This webinar unpacks the findings of a new joint data intelligence report analyzing provider network data across national, regional, state, and dental payer categories. Using publicly available provider directory data, the analysis identifies rates of provider exclusions, NPI validity, and licensing/certification issues, emphasizing the impact of having even one excluded or unlicensed provider in your network. The session also highlights Medicaid-specific findings in light of CMS’s 2026 revalidation mandate and the broader wave of state-level program integrity enforcement, and offers practical next steps for payers to strengthen ongoing monitoring between credentialing cycles.