Practice Growth · For clinicians

Health Plan Provider Directory Accuracy: What OB/GYN Practices Must Do

By the Find Her Doctor editorial team · Updated November 1, 2026 · 6 min read

Health plan provider directory accuracy is now a compliance and revenue issue, not just a front-desk annoyance. Under the federal No Surprises Act, plans must verify and update their directories on a regular schedule, and providers are expected to submit accurate information when they join or leave a network, when details change, and when a plan asks. For OB/GYN practices, getting it right means fewer misdirected patients, fewer billing disputes, and more of the right new patients.

For most practice managers the problem isn't confusion about the rules. It's volume: a dozen payers, each with its own fax, portal or vendor call, all asking slightly different versions of the same questions. The practices that handle it well treat it as a routine with an owner, not a pile of mail.

Why plan directories are so often wrong

"Ghost networks," directories listing clinicians who've moved, left the network or aren't taking new patients, have drawn complaints from patients and regulators for years. In women's health practices, the usual sources are:

  • Clinicians who left the practice but remain on group rosters
  • Office moves or suite changes never reported
  • "Accepting new patients" status that was set once and never revisited
  • Clinicians listed at every group location though they work at only one
  • Midwives or NPs listed under the wrong provider type or specialty
  • Mismatches between CAQH, NPPES and the plan's own records

The location problem is especially common in multi-site groups in the city and on Long Island, where a clinician might cover Manhattan two days and Westchester one. A patient who books the Westchester office on a Tuesday because the directory said so is a scheduling problem you created.

What the No Surprises Act requires

The No Surprises Act, in effect since 2022, includes provider directory provisions. In summary:

Health plans are expected to:

  • Verify directory information on a regular cycle (the statute refers to at least every 90 days)
  • Update the directory promptly after receiving new information from a provider
  • Remove providers who can't be verified
  • Respond to patient inquiries about network status

Providers and facilities are expected to submit directory information:

  • When a network agreement begins
  • When it ends
  • When information materially changes
  • At other times the plan requests

Patient protection: a patient who relies on a directory that wrongly shows a provider as in-network generally may be held only to in-network cost-sharing. That can leave the practice with lower-than-expected payment or a dispute to resolve.

Federal agencies have issued guidance on these provisions and signaled further rulemaking, so expect requirements and enforcement to evolve. Confirm current obligations with your payer contracts and counsel. New York has its own directory and surprise-billing protections through the Department of Financial Services, including Circular Letter No. 12 (2021) on directories and the No Surprises Act.

The New York layer: PNDS

New York adds a data source many practices don't think about. Medicaid managed care, Essential Plan, marketplace and NY-regulated commercial plans report their networks to the Department of Health's Provider Network Data System, updated at least quarterly, and that data feeds the public Provider & Health Plan Look-Up. Patients, navigators and third-party directories (ours included, for plan listings) draw on it.

In practice, that means an outdated roster at one plan can surface in more places than the plan's own website. Spot-check the state look-up for your clinicians at least once a quarter, especially after a move or departure. It won't cover self-funded employer plans or Medicare, so those still need checking plan by plan.

What plans typically verify

  • Provider name, credentials and specialty
  • Practice address(es) and which days the provider is at each
  • Appointment phone number
  • Accepting new patients (yes or no)
  • Languages spoken
  • Hospital affiliations
  • Accessibility information
  • Telehealth availability

Some plans also ask about age limits (do you see adolescents?) and whether you offer obstetric care, gynecologic care, or both. Languages deserve attention in New York: if a clinician speaks Spanish, Russian, Mandarin, Bengali or Yiddish, that field drives real patient decisions, and listing a language only the front desk speaks creates its own problems.

Responding to verification requests

Requests arrive by phone, fax, email, portal or through CAQH, and they pile up fast in a multi-clinician group.

  1. Assign one owner. Every directory request routes to the same person.
  2. Keep a master roster. One spreadsheet: each clinician, NPI, locations by day, accepting-new-patients status, languages, plan participation. See our healthcare directory listings checklist.
  3. Respond on time. A missed verification can get a clinician suppressed from the directory.
  4. Use CAQH where plans accept it. Updating and re-attesting in CAQH ProView satisfies some plans' verification needs.
  5. Log everything: date, plan, method, what was confirmed.

Fixing a wrong listing

  • Use the plan's provider portal or roster update process.
  • Send a written correction to provider relations and keep the confirmation.
  • For groups, submit an updated roster showing each clinician's actual locations and days.
  • Check the live directory after the plan's stated processing time.
  • Escalate persistent errors through your network contract contact.

Getting "accepting new patients" right

This one field causes more patient frustration than the rest combined. Decide practice-wide what it means:

  • New GYN patients only?
  • New OB patients only?
  • Only at certain locations?

If the plan's format is a bare yes or no, use notes fields where they exist. Revisit the status whenever a clinician's panel fills or opens, and tie it to whoever manages the schedule so it doesn't drift.

Clinician departures and arrivals

When a clinician leaves:

  • Notify every plan in writing, with the effective date.
  • Update group rosters.
  • Ask the clinician to update NPPES and CAQH. See updating NPPES.
  • Recheck plan directories (and the state look-up) a few weeks later.

Departures matter clinically too. A pregnant patient whose OB/GYN leaves may be entitled to transitional care, and an accurate termination date helps everyone sort that out.

When a clinician joins: listings depend on completed credentialing. Once approved, confirm each plan shows the right location, specialty and status. See adding a new provider.

A quarterly routine that takes a few hours

  • Review the master roster with clinicians
  • Spot-check each major plan's directory for each clinician
  • Check the NYS Provider & Health Plan Look-Up for state-regulated products
  • Update CAQH and re-attest
  • Confirm accepting-new-patients status
  • Log all updates

Mistakes we see repeatedly

  • Ignoring verification calls and faxes because they look like marketing
  • Updating one plan but not the others after a move or staffing change
  • Leaving CAQH unattested, which stalls updates at plans that rely on it
  • Listing part-time clinicians as full-time at every location
  • Treating directory cleanup as a one-time project

Why it pays

A wrong listing costs more than a frustrated caller. A patient who books from an outdated in-network listing may dispute the bill, and the No Surprises Act may cap what they owe. Patients sent to an office where the clinician no longer practices often book elsewhere. And repeated network-status complaints strain the payer relationship. A few hours a quarter is cheap insurance against all three.

Plan directories and public directories

Plan directories answer "Is this provider in my network?" Public directories, including ours, help patients compare by specialty, location and language. Patients use both, often in the same sitting. Claim your free listing to make sure your New York profile matches what you report to plans. Featured placement for practices that want more visibility is available at /advertise/.

Frequently asked questions

What does the No Surprises Act require of providers for directories?

Providers are expected to submit directory information to health plans when a network agreement begins or ends, when information materially changes, and when the plan requests it. Plans must verify and update their directories on a regular schedule.

What happens if a plan's directory wrongly shows a provider as in-network?

Under the No Surprises Act, a patient who relies on an inaccurate directory listing showing a provider as in-network generally can't be charged more than in-network cost-sharing. That can affect how your practice is paid.

Why does our practice still appear in a plan's directory after we left the network?

The plan may not have received or processed the termination, or the listing may come from an outdated roster. Notify the plan in writing, keep a record, and follow up until the listing is removed.

Sources

  • CMS — No Surprises Act: provider directory requirements
  • New York State Department of Financial Services — Surprise bills and emergency services
  • CAQH — ProView
  • NY Department of Financial Services — Insurance Circular Letter No. 12 (2021), provider directories and the No Surprises Act
  • NY State Department of Health — Provider Network Data System (PNDS) and Provider & Health Plan Look-Up

This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.