Ghost networks have long been a point of frustration, with health plan members sometimes left scrambling to check if a provider is in network — or available at all.
Several health insurers — including Elevance Health and Blue Shield of California, in recent months — have faced lawsuits concerning the accuracy of their provider directories. Some of these complaints said that seemingly bigger networks draw more customers, even if that appearance is ultimately misleading.
But more recent developments have pointed to ongoing issues. One study published in October found more than half of secret-shopper calls made to psychiatrists and psychologists across six Blue Cross Blue Shield plans’ directories indicated errors. Separately, this fall, UnitedHealthcare mistakenly told members that eight clinicians had died before correcting the issue.
While the No Surprises Act, state laws and CMS rules have targeted ghost networks and network adequacy before, there has been a renewed focus on getting directories right.
On Oct. 13, DataSpring, powered by CAQH, rolled out a new standard to measure provider directory data quality for individual clinicians. DataSpring convened major insurers, the American Medical Association and the National Committee for Quality Assurance to develop a framework rooted in the CMS quality foundation for provider directories.
“Patients struggle to confirm whether a clinician is in-network, providers face delays joining networks and seeing patients, and care teams often lack the reliable information needed to coordinate care,” Tim Kaja, executive vice president of UnitedHealth Group Enterprise Services and board chair of DataSpring, said. “While CMS established a method to measure provider data accuracy, inconsistent application made it difficult to establish a common baseline for improvement of provider data quality across the industry.”
Three days later, CMS proposed a rule that would have Medicare Advantage organizations estimate a “letter grade” for their directory accuracy. In the coming years, CMS would start to publicly post the scores, and plans would need to display them as well. MA organizations would need to check provider directory data at least every 90 days, with some exceptions for hospitals and other facilities.
That same proposed rule would also set protections if an MA enrollee books a provider listed as in network who ends up being out of network. Enrollees would pay no more than the lesser of the in-network or other cost-sharing for providers listed in directories.
While the rulemaking is not final and is accepting comments until Dec. 15, it would implement components of the Consolidated Appropriations Act of 2026.
“CMS has been working to improve data connectivity and accuracy in provider directories across the healthcare system,” CMS Administrator Mehmet Oz, MD, said in a news release. “The actions we are proposing today will give Medicare Advantage and Part D enrollees more reliable information, stronger financial protections and greater confidence in both programs.”
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