LANGHORNE, PA — Perspecta found persistent errors across U.S. health plan provider directories after reviewing 12 months of audits and millions of provider records, identifying data accuracy as an ongoing compliance and operational risk that periodic verification may fail to address.
The company’s State of Provider Data Accuracy report identified five fields — addresses, location names, phone numbers, fax numbers and specialties — as accounting for the vast majority of directory errors found in its analysis.
The findings carry implications beyond consumers searching for doctors. Perspecta said inaccurate provider information can affect regulatory compliance, claims processing, credentialing, network adequacy monitoring and member experience.
Industry benchmarks cited in the report put average provider data accuracy at about 50%. Perspecta also cited data showing only 31% of members trust their health plan to help them find the right provider.
“Provider data has become one of the most important operational assets for health plans, yet it’s also one of the most difficult to manage,” Mark Stamper, Perspecta’s director of data operations, said. “The findings confirm that provider data decay is not a periodic issue, but a continuous data management challenge that requires systematic, ongoing oversight.”
Perspecta’s analysis found that periodic provider attestations and manual outreach do not keep pace with changes in provider information, creating a continuing need to validate and update directory records.
The report recommends continuous auditing as an alternative to relying primarily on periodic validation. It also calls for health plans to benchmark existing accuracy, prioritize corrections to fields with the highest error rates and establish data-governance processes capable of managing information at scale.
Perspecta said continuous auditing can help health plans reduce error rates and maintain compliance as provider information changes.
“With regulatory standards tightening and member expectations rising, provider data accuracy is a fundamental requirement for healthcare operations,” Stamper said. “This research aims to give health plan leaders actionable visibility into where data breaks down and how to establish sustainable accuracy.”
The report combines Perspecta’s operational audit findings with broader industry metrics to assess the causes and consequences of inaccurate health plan provider data.
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