CMS inches toward establishing national provider directory

Modern Healthcare – Monday, July 28, 2025
By Nona Tepper

The Centers for Medicare and Medicaid Services wants to take another crack at creating a national provider directory in an effort to replace insurance company lists that are often riddled with errors.

Health and Human Services Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz touted the idea at a meeting with health information technology executives in June. In a later post on the social media platform X, CMS described its goal as a “dynamic, interoperable directory that connects the data CMS has with what the industry knows, so we all work from the same map.”

In its ideal form, a national provider directory would ease a major pain point for patients and reduce administrative costs for health insurance companies, providers and government health programs.

Related: Medicare Advantage insurers grow physician practice market share

Yet the lack of specifics from CMS and the potential pitfalls are concerning to the healthcare sector. Rather than alleviate burden, nationalizing provider lists could tangle insurers and providers in red tape while depriving some companies of a competitive advantage.

“The devil’s in the details,” said Brandon Sim, president and CEO of the value-based care company Astrana Health. “I’m broadly in favor of digitizing and standardizing things to make the process easier, but it would have to be done the right way.”

Inaccurate network lists plague health insurance customers. Insurers and providers point fingers at each other over who is to blame for out-of-date and incorrect information being presented to members seeking care.

Health insurance companies maintain that keeping provider lists truly current is practically impossible because providers enter and exit networks all year long and often fail to update insurers when they close or relocate.

The insurance industry would support a national provider directory “grounded in a robust public-private partnership,” the trade group AHIP said in a statement. At the AHIP 2025 conference last month, executives from Centene, Cigna and Aetna parent company CVS Health said their companies have met with CMS to discuss the concept.

Federal law already mandates that health insurance companies verify their provider lists every 90 days, but flaws persist across commercial, Medicare and Medicaid plans. Patients are more likely to find accurate information about in-network providers through Google searches than from their insurers, according to a study the Commonwealth Fund, a think tank, published in 2019.

In the past two years alone, policyholders have struck back, suing companies such as Centene, Cigna and Elevance Health on allegations they maintain “ghost networks” that misleadingly include nonparticipating providers. Aetna, Kaiser Permanente and Molina Healthcare have faced similar accusations.

“Insurers benefit from a lack of clarity and a lack of accuracy,” said Adam Block, founder and principal of the health insurance consulting firm Charm Economics. Block has been an expert witness for plaintiffs in “ghost network” lawsuits.

”The fact that the networks are not totally accurate at any point in time, and that there’s no single source of truth, gives them an ability to just say, ‘Hey, there’s no information on this. We are doing the best that we can,’” Block said.

The federal government has been considering a national provider directory for years.

The pending policy will be influenced by a joint initiative CMS and Oklahoma Insurance Department announced last year to create a universal directory for individual market health plans, according to the federal agency. CMS sought public input on a national provider directory in 2022 and the HHS Office of the National Coordinator for Health Information Technology hosted a workshop on the issue in 2016.

Skepticism from healthcare interests have held back the effort. “There’s basically no demand,” Block said. “There hasn’t been an impetus that has pushed us over the top to shift from this.”

Bad experiences with prior government initiatives also color the industry’s perspective on a national provider directory, Sim said. “Everyone knows the story about [electronic health records], and how that was mandated over a decade ago, and still that hasn’t gotten adoption,” he said.

To make the idea a reality, federal authorities would need to partner with insurers and contract with technology companies such as Microsoft, said Ashraf Shehata, a partner and healthcare advisor industry leader at the consulting firm KPMG.

“Since most of this is being built on cloud-enabled data sets, this is where we’re going to need to really see some of the broader solutions,” Shehata said.

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