What is Directory Review Frequency

Directory Review Definition

Directory Review Frequency is the operational rhythm that prevents "Data Decay." For C-level Payer Executives, this is no longer a "best practice" but a strict legal requirement. Under current federal mandates, plans must verify the accuracy of their directory data at least every 90 days. For Payer Ops, this creates a massive logistical challenge: the plan must reach out to every provider in the network four times a year to confirm their location, phone number, and "Accepting New Patients" status. If the frequency is managed manually through spreadsheets or sporadic phone calls, the risk of non-compliance is nearly 100%. Strategic organizations use automated "Digital Attestation" workflows that trigger notifications to providers based on this frequency, maintaining a permanent audit trail to prove to regulators that the plan is meeting its oversight obligations.

FAQs

What is the standard frequency for directory updates under the No Surprises Act?

Plans are required to verify provider data every 90 days. If a provider cannot be reached or fails to verify, they must be flagged or potentially removed from the public-facing directory.

How does review frequency impact "Ghost Networks"?

High frequency (quarterly) reduces the likelihood of "ghost" providers—those who have retired or moved but are still listed—which is a primary target for state and federal audits.

Can different data points have different review frequencies?

While the core directory (name, address, phone) is on a 90-day cycle, high-volatility data like "Office Hours" may require more frequent validation to ensure member satisfaction