When consumers choose a health plan, they assume the provider directory reflects the care providers available to them.

Too often, that’s not the case. Physicians appear in directories but aren’t actually accepting new patients, no longer practice at the listed address or have retired altogether. These “ghost networks” erode member trust, delay care and drive-up costs across the healthcare system.

The problem is widespread. A 2025 review of behavioral health networks across Medicare Advantage and Medicaid managed care found that 72% of the inactive providers included should not have been listed in the insurer’s network. For example, these providers no longer worked at any of the locations listed by the plan or they indicated they would not treat patients enrolled in a certain plan. A 2025 consumer survey showed that 33% of provider directory users have encountered outdated or incorrect information when searching for care.

The Human and Financial Cost

Ghost networks create far more than frustration. When members can’t find available providers, they face delays in care that can turn manageable conditions into acute problems. For those seeking mental health providers, these delays can be devastating.

The financial impact extends across the healthcare system. Inaccurate directories drive members to call customer service, a far more costly service channel for payers, and can lead to out-of-network claims and surprise costs for members. Health plans also incur operational costs investigating discrepancies, responding to member complaints, and defending against audits or lawsuits alleging network misrepresentation.

The erosion of trust is equally damaging. When members can’t rely on basic provider directory information, they may question their plan’s ability to coordinate care or deliver value. During open enrollment, that lack of confidence translates to member attrition as consumers switch to competitors perceived to have more reliable network directories.

Provider Data is a Moving Target

Maintaining accurate provider directories is a persistent challenge because the information changes constantly. Roughly 26% of providers experience information changes every 90 days. Physicians retire, relocate, change practice affiliations or update their surnames.

Even determining whether a provider is accepting new patients adds complexity. Practice capacity fluctuates as clinicians join or leave organizations, and patient panels shift. Status can vary by payer, line of business and even by product within a payer’s portfolio. A physician might accept new patients for one commercial plan but not another or accept Medicare but not Medicaid.

Provider organizations have little incentive to prioritize directory updates. Their focus remains on patient care and revenue management, not administrative tasks. When providers do submit data updates, they must navigate different data formats and requirements across dozens of contracted payers, creating a significant workload with limited benefit.

Regulatory Momentum Builds

The potential harm caused by ghost networks has prompted tighter federal and state oversight.

Beginning January 1, 2026, Medicare Advantage Plans must submit their provider directories to the Centers for Medicare & Medicaid Services (CMS) for inclusion in the Plan Finder tool and update them within 30 days of any changes. CMS has also revived the idea of a national provider directory, which could transform how the entire healthcare ecosystem manages provider information if executed effectively. Centralizing provider data could reduce the administrative burden created by fragmented sources and inconsistent standards.

Take Control of Provider Data Quality

The current focus on ghost networks provides a timely catalyst for health plans to strengthen their provider data management processes. A good first step is defining what accuracy and completeness mean for your organization. Set measurable standards; for example, determine how often data must be updated and what percentage of records must be verified at each cycle.

Next, identify and close data gaps. Focus on provider information that directly affects member access to care, such as practice location, availability and scheduling details. Then, establish regular data cleansing cycles. Even with strong collection methods, provider information must be systematically validated and standardized, typically monthly, to maintain quality as data ages.

Strategic partners can help supplement internal efforts with referential data - comprehensive, continuously updated information drawn from multiple verified sources. Leveraging these external datasets and advanced technologies, such as AI and machine learning, allows plans to uncover inconsistencies, reduce provider outreach, and build strong provider profiles.

The Competitive Edge of Accuracy

Ghost networks are rooted in misaligned incentives, fragmented systems and ever-changing data. But health plans that master provider data management gain a clear competitive advantage. Accurate provider directories reduce operational costs, ensure regulatory compliance and strengthen member trust through easier access to care.

Are Provider Directories Helping or Hindering Access to Care?

A new 2025 consumer survey from LexisNexis® Risk Solutions reveals both issues and opportunities related to healthcare provider directories—tools that are intended to help patients find the right doctors, specialists and facilities.  Download the full report to explore the data behind consumer experiences, usage patterns and what healthcare organizations can do to close the gap between intention and impact.