How Provider Directories and Credentialing Are Intertwined — And Why Payers Are Cracking Down

In 2025, provider directories have become a key compliance risk. CMS and commercial payers are issuing steep penalties for inaccurate listings — with fines reaching up to $25,000 per Medicare beneficiary per day. The root cause? Poor data management between credentialing and directory systems.

Why It Matters:

• CMS audits show over 50% of Medicare Advantage directories contain major errors.
• Regulators now require provider data updates every 90 days — per the No Surprise Act.
• Inaccuracies lead to denied claims, patient confusion, and surprise billing — all of which damage trust and revenue.

The Link to Credentialing:

Credentialing is the first source of verified provider data — NPI, licensure, specialty, practice location, and network status. For this reason, keeping the information up to date is critical in ensuring your providers are listed correctly in all of the insurance directories.

Best Practices:

• Track license expirations and network status changes in real-time
• Require attestation workflows and audit trails for all updates
• Use a central “source of truth” for provider data such as CAQH
• Ensure sources such as NPPES, Availity and CAQH remain updated in real time
• Provide updated information in real time as changes occur, don’t wait for the payors to
  request an update
• Respond to demographic verifications quickly and don’t ignore them

Bottom Line:

Payers are no longer tolerating bad data. By aligning your credentialing process with directory accuracy, you reduce regulatory risk, protect revenue, and improve the patient experience.

1st Credentialing manages all of this (and more!) for you when you participate in our maintenance plan. If you need help keeping your provider data clean and compliant, give us a call!

Speak with us to learn more!

Questions? Contact us. Call Today: 512-201-2668 | Book an Appointment | 1stcredentialing.com

At 1st Credentialing, we look forward to partnering with you today!