When consumers choose a health plan, they expect its provider directory to accurately reflect the care available to them. Too often, it does not.

Physicians may appear in directories even though they are not available for new patients, no longer practice at the listed address or have retired. These inaccurate listings contribute to what are called “ghost networks,” which can erode member trust, delay care and increase costs.

A 2025 review of behavioral health networks across Medicare Advantage and Medicaid managed care found that 72% of inactive providers listed should not have been included in a health insurer’s network because they no longer worked at the listed locations or would not treat patients enrolled in certain plans.¹ 

In 2025, we conducted a consumer survey that uncovered an alarming finding: 33% of provider directory users have encountered outdated or incorrect information when searching for care.² 

The human and financial cost of ghost networks

Ghost networks create more than frustration. When members cannot find available providers, care can be delayed and manageable conditions can become acute. For people seeking mental health care, the risk can be especially serious.

The financial consequences can also be significant. Inaccurate directories can drive members to higher-cost customer service channels, contribute to out-of-network claims and create unexpected costs for members.

Health plans may also face added operational costs as they investigate discrepancies, respond to complaints and defend against audits or lawsuits alleging network misrepresentation.

The erosion of trust can be equally damaging. If members cannot rely on basic directory information, they may question whether their health plan can coordinate care or deliver value. During open enrollment, that lack of confidence can contribute to attrition.

Provider data is a moving target

Maintaining an accurate provider directory is an ongoing challenge because provider information changes constantly. Roughly 26% of providers experience information changes every 90 days as physicians retire, relocate, change practice affiliations or update their surnames.³ 

Determining whether a provider is accepting new patients adds another layer of complexity. Capacity shifts as clinicians join or leave healthcare organizations and patient panels change.

Acceptance status can also vary by payer, line of business and product.

Provider organizations may have little incentive to prioritize directory updates. Their focus remains on patient care and revenue management, not administrative tasks that require different data formats and requirements across dozens of contracted payers.

Regulatory momentum builds

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

As of January 1, 2026, Medicare Advantage plans must submit their provider directories to the Centers for Medicare & Medicaid Services in a standardized format for inclusion in the

Medicare Plan Finder tool. Health plans must update directory information within 30 days of a change and attest to its accuracy at least once a year.⁴ 

Take control of your provider data quality

The increased focus on ghost networks gives health plans a timely reason to strengthen provider data management.

A strong first step is defining what accuracy and completeness mean for your organization. You can establish measurable standards for update frequency and record verification.

You can then close gaps in the information that directly affects access to care, including:

• Practice location
• Provider contact information
• Provider specialty/subspecialty area of care
• Provider availability
• Scheduling information

Establishing a regular cycle for data validation and cleansing is equally important. Even strong collection methods require systematic validation and standardization as provider data changes.

Strategic data partners can supplement these efforts with referential provider data, which includes continuously updated information drawn from multiple verified sources. External datasets, artificial intelligence and machine learning can help to identify inconsistencies, reduce provider outreach and build stronger provider profiles.

Turn directory accuracy into your competitive advantage

Ghost networks are rooted in misaligned incentives, fragmented systems and constantly changing data. Health plans that prioritize provider data management can turn directory accuracy into your competitive advantage.

More accurate, reliable provider directories can help reduce operational costs, support regulatory compliance and strengthen member trust by making it easier to access care.

Are your provider directories helping or hindering access to care?

Our 2025 consumer survey report explores provider directory issues and opportunities, including consumer experiences and usage patterns.

Download the full report to explore the findings and learn how health plans can close the gap between intended directory value and members’ actual experiences. 

References:

1. U.S. Department of Health and Human Services Office of Inspector General. Many Medicare Advantage and Medicaid Managed Care Plans Have Limited Behavioral Health Provider Networks and Inactive Providers. 2025. https://oig.hhs.gov/reports/all/2025/many-medicare-advantage-and-medicaid-managed-care-plans-have-limited-behavioral-health-provider-networks-and-inactive-providers/.
2. LexisNexis Risk Solutions. Provider Directory Utilization: Consumer Insights Survey 2025. 2025. https://risk.lexisnexis.com/insights-resources/research/provider-data-survey.
3. Internal data analysis conducted by LexisNexis® Risk Solutions based on data available as of 2024. Findings and conclusions reflect conditions known at that time and may not reflect subsequent developments, updated information, or current market conditions.
4. Centers for Medicare & Medicaid Services. Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (PACE) - Finalization of Format Provider Directories for Medicare Plan Finder. 2025. https://public-inspection.federalregister.gov/2025-18236.pdf.