Latest News: Development of a National Provider Directory

Back in June, I was on the Monitor Mondays broadcast discussing the initial momentum within the Trump Administration for a single, national provider directory.

Now, after seeing a small flurry of activity over the past few weeks, I thought an update might be warranted.

The long-debated idea of a sole, national provider directory from a singular authority, which dates back to 2022 and the Biden Administration, is taking its first concrete steps forward. Following multiple public forums and stakeholder engagement efforts several months ago, as well as the launch of the “Make Health Tech Great Again” initiative, which revealed provider directory ambitions, the Centers for Medicare & Medicaid Services (CMS) has now expanded its Medicare Plan Finder tool, which helps consumers shop between plans, to include Medicare Advantage provider directory information.

And last week, the agency also quietly issued four proof-of-concept awards to vendors to help build what could become a National Directory of Healthcare (NDH).

As a quick reminder, some of the typical talking points used to promote the need for a national directory include the idea that provider directories today are fragmented and frequently inaccurate — a persistent source of “ghost network” problems where plans list clinicians or facilities that are no longer in network or are no longer practice.

And just a couple weeks ago, a report from the Health and Human Services (HHS) Office of Inspector General (OIG) found that many Medicare Advantage (MA) and Medicaid managed care plans have limited behavioral health provider networks, with up to 99 percent of behavioral health listings in some directories qualifying as “ghosts.”

That inaccuracy can be quite problematic for beneficiaries trying to find in-network care and creates administrative headaches for providers and plans that must continually reconcile directory listings. As a result, the feds maintain that a centralized, interoperable directory holds promise for cleaner data, fewer surprise out-of-network encounters, and a single point of truth for healthcare provider data.

So, what has CMS been up to since June?

In August, the federal agency said the Contract Year 2026 Medicare Plan Finder would include MA provider directory information and other consumer-facing enhancements. CMS described that it was considering using a third-party vendor to populate the Plan Finder with in-network provider and facility data as a potential operational approach.

Then, in late September, CMS followed through, posting multiple small contracts to four separate companies to run proof-of-concept work exploring elements of a national directory. The awards, made public at the beginning of this month, are intended to test technical approaches, data models, and governance ideas rather than to deliver a finished product.

Current reporting indicates that vendors under consideration include large data and analytics firms such as Availity, the Council for Affordable Quality Healthcare (CAQH), Palantir, and Gainwell Technologies.

While inclusion of provider directory information in the Medicare Plan Finder is actively moving forward, other regulatory elements have been delayed allowing more time for stakeholder input and to balance accuracy requirements with administrative burden.

In short: The Plan Finder will start showing provider lists, but the administration’s larger, National Directory of Healthcare providers will be an iterative effort. CMS has more work to come in this space, but they have clearly moved from conceptual talk to testing.

The convergence of key Medicare Plan Finder enhancements and small-scale vendor proofs represent the first pieces of tangible progress toward a long-sought infrastructure goal that, if executed well, could simplify care navigation and reduce discrepancies between patients and in-network providers.

But whether a national provider directory operated by the government will solve the deeper problems of data accuracy and governance depends on the technical results of these vendor proofs and the policy choices CMS makes next.

References:

1. https://www.beckershospitalreview.com/healthcare-information-technology/ehrs/cms-advances-national-provider-directory-with-4-1m-contracts/
2. CMS signals interest in Palantir for national provider directory project  | FedScoop
3. https://www.cms.gov/newsroom/press-releases/white-house-tech-leaders-commit-create-patient-centric-healthcare-ecosystem
4. Medicare Advantage open enrollment provider directory mired in errors – The Washington Post
5. https://oig.hhs.gov/reports/all/2025/many-medicare-advantage-and-medicaid-managed-care-plans-have-limited-behavioral-health-provider-networks-and-inactive-providers/