Understanding accurate provider data in healthcare ecosystem

Accurate provider data is foundational to the healthcare ecosystem. It guides decision-making, helps patients access the care they need, and keeps operations running smoothly behind the scenes. And while we’ve all acknowledged the challenge of keeping provider data up-to-date and error-free—especially with frequent changes in practice locations, credentials, and network participation—what we don’t talk about enough are the tangible successes we’ve seen when data is handled correctly. We’re not merely caught in a loop of obstacles; we’re building momentum toward meaningful solutions.

With over 4.8 million provider records in our system, CAQH has been at the forefront of tackling this issue head-on. We believe it’s time to shift the conversation from what’s broken to what’s working—and how it can get better. As healthcare transforms, bold solutions are finally taking root, and there’s plenty to be optimistic about.

Solving big problems with proven strategies
When one of the nation’s largest payers was struggling with outdated data, they leveraged CAQH for a smarter, more efficient way to clean up its records without overwhelming providers. CAQH Directory Management solutions help health plans solve the persistent challenge of maintaining accurate provider directories. Within three months, an audit revealed that 76% of providers in the network had updated and attested to their information, and 20,000 outdated records were removed. By replacing over a million manual calls with automated outreach, the plan saw a significant boost in both provider engagement and satisfaction, all while achieving an 84% directory accuracy rate—far above the national average.

Ballad Health, a 21-hospital system with 800 physicians, also transformed its provider data management with CAQH. By automating the submission of rosters to multiple health plans through the CAQH Provider Data Portal, Ballad drastically cut down on time-consuming manual processes. Data is pulled weekly, standardized into a format required by 30 different health plans, and quality-checked before submission. This streamlined approach has reduced the time needed to process rosters by 50%, while improving data accuracy and ensuring compliance across their network.

What’s next: The evolution of provider data
The future of provider data management focuses on creating a more streamlined experience for both providers and health plans. CAQH is developing an innovative solution that reimagines the provider data lifecycle, with the goal of enhancing data accuracy and enabling real-time updates. The solution seeks to ease the burden of manual processes and outdated information, fostering a smoother, more dynamic flow of data.

This not only keeps pace with regulatory requirements and reduces administrative burden—it’s about a fundamental shift in how the industry views and uses provider data. With this new approach, we can proactively address issues before they become barriers to care, ensuring information moves more easily between providers, payers, and patients.

Why provider data matters now more than ever
Why all this focus on provider data? Because, at its core, it drives the healthcare experience. Patients rely on accurate directories to find in-network care. Providers need seamless credentialing processes to spend more time treating patients. And health plans need accurate provider information to ensure they meet regulatory requirements, avoid costly fines, and optimize network management, all while facilitating smooth claims processing and ensuring members have access to the right providers at the right time. Whether it’s a patient’s trust in their health plan or a provider’s ability to deliver care, it all comes back to data.

At CAQH, we’ve seen what happens when you get it right. We’ve also seen the frustration when systems fall short. The good news? Solutions exist, and they’re working. Whether it’s saving millions of hours in unnecessary phone calls or ensuring that patients can find a doctor when they need one, accurate provider data is driving these wins. Healthcare IT Today