New provider directory standard means more calls for practices
DataSpring's new directory accuracy standard requires quarterly outreach to practices. What it means for front desks, ANP status, and directory software.
What is the new provider directory accuracy standard?
On October 13, 2026, DataSpring (powered by CAQH) published a measurement standard for provider directory accuracy, developed by its Provider Data Collective. The founding members are Aetna, Centene, Cigna, Elevance Health, Horizon, Humana, UnitedHealth Group, the American Medical Association (AMA) and the National Committee for Quality Assurance (NCQA).
The standard covers eight fields for individual clinicians: name, address, appointment phone, accepting new patients (ANP), specialty, health plan accepted, practice name and gender. Each error carries a weight.
How are directory errors scored?
| Error | Points lost |
|---|---|
| Clinician listed at a location where they don't practice | 100 |
| Appointment phone can't book an appointment, or doesn't connect after 3 tries | 100 |
| Accepting-new-patients status is wrong | 100 |
| Health plan isn't accepted at the location | 75 |
| Specialty is wrong | 75 |
| Street address is wrong | 60 |
| Gender is wrong | 10 |
| Suite number, clinician name or practice name is wrong | 5 each |
Blank fields, "unknown" and "not available" are all scored as errors.
Plans calculate two scores: a weighted accuracy score, and a stricter one where any single error fails the whole record. A common method is overdue. Every plan and regulator has measured differently, so nobody could say whose directory was actually better.
Why will practices get more verification calls?
Here is what bothers me. The document opens with DataSpring's own survey data: more than a quarter of practices field over 15 verification calls a month, and 40 percent of those calls run past 15 minutes. Then it requires every adopting plan to audit at least quarterly through direct outreach to the practice, and recommends secret shopper calls. Claims data can supplement the calls but cannot replace them.
So the answer to verification-call burden is a standardized schedule of verification calls. Multiply quarterly audits by every payer a practice participates with, and the front desk answers more of these, not fewer. Unless plans share results through DataSpring instead of each calling separately, the burden the standard cites as its reason for existing gets heavier.
Isn't quarterly verification already required?
Not in this form. Since 2022, the No Surprises Act has required health plans to verify every directory listing at least once every 90 days, and to have a way to remove providers they can't verify. The standard's quarterly audit is a separate, scored check on a sample of listings, done by calling the practice, on top of that verification. The calls don't replace each other. They stack.
It also means an unanswered verification call isn't harmless. A plan that can't verify a listing can take it down.
Why does accepting-new-patients status matter most?
For practices, the field to watch is ANP. It's one of three 100-point fields, it goes stale faster than the others, and the Collective has already named it as its next project. Whoever answers the phone needs to know the current answer by location and by plan.
What should practices do now?
- Call the appointment number in each directory and see what a caller reaches. A number that can't book an appointment, or doesn't connect after three tries, loses the full 100 points.
- Take clinicians off locations where they no longer practice. Every listed location is scored on its own, so one old satellite office fails that whole listing.
- Give one person ownership of accepting-new-patients status for each location and plan, and update the plans when it changes, not when the next call comes.
- Answer verification requests. A plan that can't verify your information can remove you from its directory.
What should credentialing and directory software support?
For anyone building credentialing or directory software, look at the optional measures. The consistency check compares directory data against credentialing and claims systems. The validity checks use the value sets from the HL7 Da Vinci PDex Plan Net implementation guide. Design for both now rather than retrofitting later.
Read the standard: Provider Data Quality Measurement Standard, v1.0 (PDF).
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About the author
Tony Kuka · Founder, Ziurta
Tony is the founder of Ziurta, a provider enrollment platform for medical practices, health systems, RCM firms, and credentialing companies. He has 30 years in healthcare administration, including 20 building outsourced revenue cycle companies, and founded and sold Medical Business Office and National Credentialing Solutions. He is based in Chattanooga, Tennessee.