CAHPS Patient Satisfaction Survey: Why Directory Accuracy Is Your Hidden Member Experience Lever

Your member satisfaction scores don't start with clinical outcomes they start the moment someone opens their phone and tries to find a doctor. That's where CAHPS happens in the real world, even though survey methodologists don't always frame it that way.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey measures how members actually experience your plan. It captures their ability to access care, their ease in navigating the system, and their overall confidence in your organization. But here's the uncomfortable reality: a significant portion of CAHPS dissatisfaction stems from something most plans treat as a technical operations issue inaccurate provider directories.

According to Atlas Systems’ 2025 Member Experience Monitor that surveyed 1,000 insured Americans about their actual experience with provider directories, 80% of members who encountered incorrect provider directory information said it made them trust the insurance company less. That's not a technical problem anymore. That's a member experience problem. And it shows up directly in CAHPS scores.

What CAHPS Actually Measures (And Why Directory Matters)

CAHPS doesn't explicitly ask about directory accuracy. Instead, it captures three domains that are directly touched by how clean your provider data is:

• Access to care: "How easy was it to get an appointment?" When directory information is wrong, members face delays or dead ends that directly impact this rating.
• Ease of use: "How easy was it to navigate your plan's systems?" Directory errors create friction here members can't find providers, calling customer service, getting wrong information.
• Overall satisfaction: "How would you rate your health plan?" Trust erosion from directory problems bleeds into overall sentiment.

When a member searches your directory and finds outdated information, they don't separate that from their impression of your plan. They experience it as your organization being disorganized, indifferent, or incapable. And these moments accumulate.

The Member Journey: Where Directory Errors Hurt Most

Consider what actually happens when a member tries to find care:

A member opens your directory looking for an in-network cardiologist. They find one, get excited, then call the office number and reach a dental practice. Or they drive to the listed address and find a building that's been repurposed. Or they discover the provider is no longer accepting new patients, but your directory still lists them as open.

Each of these moments creates friction. And each one reinforces a narrative: "This health plan doesn't have accurate information about its own network."

The research backs this up. Among members who found directory errors, the most common issues were:

• 49% learned a provider wasn't accepting new patients
• 30% received a surprise medical bill due to network confusion
• 27% contacted the wrong office
• 24% found the provider had retired or passed away
• 19% traveled to the wrong practice location

These aren't minor inconveniences. They're moments where your plan either meets member expectations or fails them. And they happen early in the member journey often before they even engage with clinical care.

Why This Matters for CAHPS Scores (And Your Financial Performance)

CAHPS results directly influence bonus payments and Stars ratings. For Medicare Advantage plans, a half-point improvement in Stars translates to tens to hundreds of millions in additional annual revenue. But you don't earn those bonuses without proving that members are satisfied with their experience accessing care.

If your directory is creating friction, your CAHPS access scores suffer. If access scores decline, your Stars decline. If Stars decline, your reimbursement and enrollment leverage decline.

It's a direct line. And most health plans don't acknowledge it until their CAHPS results come back lower than expected.

The Operational Reality Most Plans Face

Here's the truth: most health plans don't have unified ownership of provider data accuracy. The directory team pulls data from CAQH. Claims systems have their own provider master file. Credentialing platforms maintain separate records. Salesforce holds yet another version.

When these systems are out of sync which they usually are members encounter contradictions. A provider shows as active in the directory but inactive in claims. Or a plan terminated a provider, but the directory wasn't updated for weeks.

This fragmentation is structural, not negligent. Delegated credentialing means providers submit their own updates. External data feeds are only as current as the source's last refresh. Manual processes create lag. And without real-time visibility across systems, you have no way of knowing where discrepancies live until members report them and they've already impacted CAHPS sentiment.

Building a Directory Accuracy Program That Improves CAHPS

If you want to move the needle on member satisfaction, start by mapping where your directory errors are most likely. The highest-impact fields are:

• Whether a provider is accepting new patients
• Accurate office phone numbers for scheduling
• Current office addresses with correct suite numbers
• Current specialty information
• Insurance acceptance status

These are the first things members check. And errors here have an outsized impact on satisfaction.

Next, establish a data validation framework that goes beyond your current process. Most plans rely primarily on CAQH. But CAQH is only as good as what providers submit. Strengthen this by validating against provider websites directly (the most accurate single source), cross-checking against other plan directories in your region (consistency increases confidence), and conducting outreach to verify discrepancies.

Then integrate findings back into your CAHPS strategy. When you discover a cluster of directory errors in a certain geography or specialty, prioritize updates there. Track how directory accuracy improvements correlate with CAHPS scores in those segments. You'll likely find that focused effort on high-impact fields yields measurable CAHPS gains within months.

Finally, establish ongoing monitoring. Member experience doesn't improve through annual directory refreshes. It improves through continuous vigilance. This requires automation and a unified data management system, not spreadsheets and quarterly audits.

Where PRIME® Fits Into Your Directory Accuracy Strategy

Real-time provider data management matters because it prevents the gaps that frustrate members and depress CAHPS scores. PRIME® Provider Directory Validation takes a multi-layered approach to ensure your directory reflects reality:

Primary source validation starts with provider websites, the most accurate and up-to-date source. PRIME® collects details directly, since providers typically update their own sites first.

Cross-check with public sources like NPPES, CMS Care Compare, SAM.gov, and state medical boards to verify specialty, NPI, licensure status, and sanctions.

Network consistency checks compare provider details across multiple payer directories in your region. Consistency across plans increases confidence that data is correct.

AI-assisted outreach handles routine verification when data points are missing. This fills gaps without requiring human intervention on every record.

Human verification for exceptions escalates to live call center agents only when AI detects conflicts or when critical information is still missing. This keeps costs low while ensuring accuracy.

The result is a verified provider record that is validated across multiple sources, checked for sanctions, confirmed as currently practicing, and documented with audit trails showing exactly what was verified and when.

This unified approach solves the fragmentation problem. Instead of managing provider data across disconnected systems, you have one source of truth that feeds your directory, claims system, credentialing platform, and member-facing tools. Updates propagate in real-time, discrepancies get caught before members encounter them, and audit trails give you defensibility if questions arise.

Most importantly, your members find accurate information, providers match reality, networks make sense, and trust in your plan doesn't erode.

Why PRIME®?

Organizations partner with PRIME® because we focus on fixing the root cause, not just correcting what’s already broken. The goal isn’t endless cleanup cycles; it’s designing processes that stop inaccuracies before they spread. From strengthening first-point data capture to easing provider follow-ups and maintaining audit-ready documentation, PRIME® is built to support stability over time, not short-term patches.

If spreadsheets, periodic audits, or manual reconciliations are still holding your processes together, it may be time to reassess.

Connect with our team to explore how our provider data and compliance solutions can help protect your directories, support your members, and strengthen your organization’s credibility.

FAQs

1. What exactly does CAHPS measure about provider access?

CAHPS includes specific questions about member experience with getting care, such as "How easy was it to get an appointment?" and "How often did you get the care you needed as quickly as you thought you needed it?" When provider directory information is inaccurate, members encounter delays or dead ends that directly impact these responses.

2. How much does directory accuracy actually affect CAHPS scores?

The research shows that 80% of members who found directory errors reported reduced trust in the health plan. This loss of trust correlates with lower satisfaction ratings on CAHPS surveys, particularly in access and overall plan rating domains. Plans with high directory accuracy typically see measurable CAHPS improvements within 6-12 months of implementing validation programs.

3. Can we improve CAHPS without fixing the directory?

Partially, but you're fighting friction. You can improve customer service response times and make appeal processes faster, but if members can't find a provider when they open your directory, those improvements feel inadequate. Directory accuracy is foundational.

4. Which provider data fields matter most for CAHPS?

The highest-impact fields are: (1) whether a provider is accepting new patients, (2) current phone numbers for scheduling, (3) office address with correct suite numbers, (4) current specialty information, and (5) insurance acceptance. These are what members check first, and errors here have outsized impact on satisfaction.

5. How do we measure directory accuracy improvement against CAHPS outcomes?

Establish a baseline audit of error rates across your directory. Implement ongoing validation processes and measure error reduction over time. Then measure the correlation with CAHPS scores in affected member segments. The real metric is whether directory accuracy improvements translate to higher satisfaction ratings.

6. How long does it take to see CAHPS improvement from directory accuracy work?

Most plans see measurable improvement within 2-3 months if they focus on high-impact fields and member-facing segments. Sustained improvement requires ongoing validation, not one-time remediation.