No Surprises Act Provider Directory Requirements Explained

Maintaining accurate and up-to-date provider information has long been a challenge for healthcare organizations. Patients rely on online directories to find in-network doctors, hospitals, and clinics. However, when these listings are outdated or incomplete, patients may end up receiving care from out-of-network providers, leading to unexpected medical bills, an issue the No Surprises Act (NSA) helps prevent. 

For example, in 2023, more than half of U.S. consumers reported finding incorrect information in provider directories, wrong phone numbers, addresses, or network status.  With such incidents on a raise, the No Surprises Act provider directory requirements were introduced to make healthcare billing more transparent and fair.

The rules ensure that patients can easily verify whether a provider is in-network and avoid unexpected charges. To meet these standards, insurers and healthcare organizations must regularly verify, correct, and update their directory data.

This blog explains what the No Surprises Act provider directory rules mean, covers the challenges organizations face in staying compliant, and highlights how Atlas Systems can help maintain accuracy, reduce manual work, and support compliance.

Key Requirements for No Surprises Act Provider Directories

The No Surprises Act has clear rules for keeping provider directories accurate and reliable. These rules make sure patients can find the right doctors and avoid surprise medical bills. Both health plans and providers must follow them carefully.

Here are the main requirements:

1. Verify information every 90 days

Health plans must check all provider details at least once every 90 days. This includes the doctor’s name, specialty, address, phone number, and whether they are in the network. Providers must also inform the plan whenever any of their information changes.

2. Update changes quickly

If any provider information changes, health plans must update their directory within two business days. This helps patients get the most accurate information whenever they search for care.

3. Show who is in-network

Directories must clearly show which doctors and hospitals are in-network and which are out-of-network. This helps patients understand what services are covered and what might cost more.

4. Make directories easy to access

Patients should be able to easily find provider information online. Health plans also need to share printed copies or phone support if someone requests it, so everyone can access the information they need.

5. Give correct answers to patients

If a patient asks about a provider’s network status, the health plan must give the correct information. If the plan gives wrong details and the patient gets a surprise bill, the patient does not have to pay the extra amount.

Read: Provider Data Validation: Why It's Crucial and How to Do It

Maintaining No Surprises Act Provider Directory Accuracy Across Provider Networks 

Keeping provider directories accurate is not a one-time task. Information about doctors, hospitals, and clinics changes often, providers move, update their contact details, or change their network status. If these updates are missed, directories quickly become unreliable and non-compliant with the No Surprises Act provider directory requirements.

Here are some practical ways healthcare organizations can maintain accuracy and compliance:

1. Set clear data ownership

Each department or team should know who is responsible for collecting and updating provider information. Having a clear process reduces confusion and helps ensure that updates don’t fall through the cracks.

2. Use automated verification tools

Manual updates are time-consuming and prone to errors. Automation tools, such as PRIME® by Atlas Systems, can automatically verify provider details, flag outdated information, and send alerts when updates are needed. This makes compliance easier and faster.

3. Standardize data formats

Provider information often comes from multiple systems. Standardizing the format, for example, how addresses or specialties are recorded, helps maintain consistency across databases and reduces duplication.

4. Track and log every change

Keeping a record of all updates and verifications is an important part of provider directory compliance. It shows that your organization is actively maintaining its listings and can be useful during audits.

5. Conduct regular audits

Internal audits help identify data errors before they become compliance risks. Reviewing a small sample of records every month can make a big difference in keeping your directory accurate.

6. Make updates simple for providers

Giving providers an easy way to confirm or correct their information, such as through a secure online portal, improves accuracy and reduces back-and-forth communication.

This may interest you: How to Improve Provider Data Accuracy in Healthcare?

Common No Surprises Act Provider Directory Compliance Challenges and Penalties

Maintaining provider directory accuracy is not easy, especially for large health systems managing hundreds of providers across multiple locations. Even small errors can lead to big compliance issues under the No Surprises Act provider directory requirements.

Below are some of the most common challenges organizations face and the possible penalties for not meeting compliance standards.

Keeping up with these requirements manually is difficult and expensive. PRIME® by Atlas Systems makes it much easier. It automatically verifies information, flags outdated records, and maintains complete audit trails. 

How Technology Simplifies No Surprises Act Provider Directory Compliance 

Managing provider directories manually is time-consuming and error-prone. With constant updates in provider information, healthcare organizations need reliable technology to maintain accuracy and compliance with the No Surprises Act provider directory requirements.

By integrating provider directory management with the right technology solutions, organizations can reduce administrative effort, improve data consistency, and ensure that patients always have access to correct and updated information.

Here’s how technology helps:

1. Centralized data management

A unified system brings provider data from different sources, such as credentialing, enrollment, and claims, into one place. This ensures that everyone in the organization works with the same verified information.

2. Automated verification and alerts

Automated tools can check provider details regularly and send alerts when data needs to be updated. This helps organizations meet the 90-day verification rule and the two-business-day update requirement without missing deadlines.

3. Real-time data sharing

Integration between payer and provider systems enables real-time updates. When a provider’s address or network status changes, it automatically reflects across all directories, preventing outdated or conflicting records.

4. Built-in compliance tracking

Modern platforms keep a full history of changes and verifications, making it easier to demonstrate compliance during audits. Having accurate, time-stamped records reduces risk and simplifies reporting.

5. Self-service options for providers

Allowing providers to log in and confirm their own details speeds up updates and reduces data entry errors. It also makes it easier for them to stay engaged in maintaining directory accuracy.

Explore key insights from our 2025 Member Experience Monitor survey on provider data accuracy, member trust, and digital experience.

Ensuring No Surprises Act Provider Directory Accuracy with PRIME® by Atlas Systems 

Accurate and compliant provider directories are essential for healthcare organizations to stay audit-ready, avoid penalties, and deliver better member experiences.

What is PRIME® by Atlas Systems?

PRIME® by Atlas Systems is an AI-powered, end-to-end provider lifecycle management solution designed to help health plans and provider organizations maintain accurate, validated, and compliant provider data. It integrates seamlessly with existing systems, supports FHIR standards, and automates key processes across the provider network.

How PRIME® by Atlas Systems supports healthcare organizations

• Data accuracy and validation: PRIME® by Atlas Systems ensures 98% provider data accuracy through a primary-source verification model. It connects directly with providers via automated outreach and self-service updates, reducing dependence on manual processes.
• Regulatory compliance and audit readiness: Atlas PRIME® simulates CMS and state audits to identify data gaps and compliance issues early. It also generates ADA-compliant directories that meet CMS accessibility and format requirements.
• Automated updates and centralized workflows: PRIME® enables seamless updates through integrated workflows that bring all provider data, credentialing, rosters, affiliations, into one unified system.
• Provider engagement and self-service: Providers can review and correct their data through an intuitive portal, improving response times and data reliability while easing the administrative load on payer teams.
• Comprehensive coverage: Whether managing individual practitioners, hospital networks, or delegated entities, PRIME® by Atlas Systems adapts to complex organizational needs with flexible configuration and automation.

Proven impact

A leading New York health plan achieved 98% data accuracy using PRIME®, improving member satisfaction and reducing compliance risks. As one data leader noted, “The biggest differentiator in PRIME® is their primary data verification model, which means they reach out to every single provider.”

Check this out: A Complete Guide to Provider Network Management in Healthcare

See how PRIME® by Atlas Systems can simplify your provider directory management - Schedule a demo today.

FAQs on No Surprises Act Provider Directory

1. What are the main requirements for No Surprises Act provider directories?

Healthcare organizations must keep their provider directories accurate and up to date. They need to verify provider details at least every 90 days and update any changes within two business days. This includes names, specialties, contact details, and network status.

2. How does the No Surprises Act impact provider directory accuracy?

The Act requires health plans to ensure patients can rely on directory information when choosing in-network providers. If directories show outdated or incorrect details, it can lead to billing mistakes and compliance violations.

3. What penalties exist for non-compliance with the No Surprises Act?

Non-compliance can lead to regulatory fines, loss of patient trust, and reputational damage. Inaccurate listings can also result in surprise medical bills, which can trigger further investigations and penalties from federal or state agencies.

4. How often should provider directories be updated to remain compliant?

Provider directories must be verified at least once every 90 days. Any new or corrected information should be updated within two business days of receiving it from the provider.

5. What tools help healthcare organizations maintain compliant directories?

Automated solutions like Prime® by Atlas Systems help collect, verify, and update provider data efficiently. They reduce manual work, improve accuracy, and create audit-ready records for compliance checks.

6. How can audits improve accuracy and prevent regulatory fines?

Regular internal or mock audits help identify errors before they become compliance issues. Tools like Prime® by Atlas Systems also offer simulated audits that highlight data gaps and guide teams in fixing them early.