Remove the Ghosts from Haunted Provider Directories: 5 Things Payers Should Know

Payers place many resources—including time, personnel, and money—into maintaining provider networks for their plans and members. What is the intended goal after negotiating and contracting with networks? An accurate and comprehensive provider directory containing in-network clinicians and specialists that members can effectively use to “find a doctor” when they need care. 

In reality, though, this is often an elusive goal.  Members frequently find themselves haunted by ‘ghost networks’  – directories with listings for doctors who are no longer practicing, not accepting new patients, out-of-network, or have listings with inaccurate addresses, phone numbers, and websites. Those lists, constructed from bad or inaccurate data, contain inaccurate information that can hide network inadequacy. Patients have made lawmakers aware of their frustrations with delayed care and unexpected, sometimes life-altering surprise bills due to a ghost networks. Lawmakers have listened.

In 2023, the Senate Committee on Finance conducted a study of Medicare Advantage mental health care providers in provider directories and found that “more than 80% of the listed, in-network, mental health providers staff attempted to contact were therefore ‘ghosts,’ as they were either unreachable, not accepting new patients, or not in-network.” Results such as this have prompted legislators to propose legislation at both the federal and state level to require payers and providers to address the ghost network problem.

As patients advocate for change and elected officials take note, payers and providers should prepare for the mandates that are coming.  Check out five key considerations around legislative efforts to address ghost networks and improving transparency in provider directory data management from HIT Consultant.