Can AI fix healthcare provider directories?

It’s time for a smarter approach.

There is a lot of buzz around artificial intelligence (AI) right now.

Millions of people rely on AI-powered voice assistants like Alexa and Siri as a normal part of life. Everyone is familiar with Netflix and other streaming video services suggesting what to watch next. Google auto-filling online forms is a great time-saver, albeit a nuisance at times. AI is no longer science fiction — it’s mainstream.

Just about every industry has been employing AI technology to create efficiencies and improve quality for decades. And healthcare is no exception. Supporting patient care outcomes is top of mind, yet AI can also substantially improve administrative processes.

One area where AI shows promise is improving data quality in health plan provider directories.

Provider directory data changes frequently — practice locations, phone numbers, health plan participation, whether new patients are being accepted — it’s not easy to keep up with the latest information. People have been deliberately trying to capture all of these changes to improve directory quality, but so far, haven’t moved the needle. Despite years of effort to address provider data deficiencies, about half of provider directory data is still inaccurate, according to recent audits by the Center for Medicare and Medicaid Services.

Inaccurate directories impact access to care and policymakers are demanding action. Maybe AI can be the bright light at the end of the tunnel.

Incorporating AI technology is not meant to imply completely changing how provider data is collected. There are already efficient solutions that streamline data sharing and keep providers readily engaged in the process. Instead, it’s about getting smarter around these processes — blending in AI capabilities to optimize what is working and appreciably increase data quality.

Provider data has long been confirmed by health plans picking up the phone and calling the provider. Now, recently developed AI technology lets health plans know if provider information is correct, without needing to individually contact the provider.

AI can quickly assess massive amounts of data that otherwise would require considerable work by a person. For example, a simple mileage calculation through Google maps can be a key indicator of practice location accuracy. Most people aren’t willing to travel more than 100 miles each way on their daily commute. Using AI to measure the distance between a practice location and a provider’s home address can easily flag dubious data.

In some cases, AI can detect a data error as it is being entered and instantly prompt for a correction. Even better, AI sharpens as it gets more information, so data quality can perpetually improve.

Applying AI technology to make directories more accurate has a positive downstream effect: It can streamline information sharing between health plans and providers.

Validating directory information, such as an office location, can be as simple as AI independently assessing its probability of accuracy. Time and money savings are on the table for both health plans and providers. Scoring data without contacting the provider reduces the need for individual outreach by health plans. Providers are no longer burdened with a regular barrage of calls, emails, and mailers asking for information updates.

But the real winners will be consumers. At some point, everyone is a patient and relies on directory information to find providers and schedule appointments. Improving directory accuracy removes barriers in access to care and makes the healthcare experience that much better for everyone.

So, can AI help fix healthcare provider directories? All signs point to yes. There has been some progress on this front and technology is continually learning from various sources of provider data in the industry. AI may not be a silver bullet to solving this conundrum, but it is certainly a powerful tool. When combined with efficient processes and engaged providers, AI just may be one really smart way to improve provider directories.


Hassaan Sohail is a Product Manager for CAQH, which started solving problems with provider data management more than a decade ago. The organization convenes key healthcare players to develop industry-wide solutions that simplify business processes. CAQH Solutions are designed to create efficiencies and reduce administrative burden for both healthcare providers and health plans.