On Monday morning, a health plan’s provider data management team begins another round of provider verification outreach. By Wednesday, several of those records are already outdated. A physician has joined a new medical group. One office stopped accepting new Medicare patients. Another physician relocated. Meanwhile, provider organizations are buried in repetitive enrollment and verification requests, and patients and members are left navigating online provider directories that often reflect what was true months ago, not what’s true today.
Health plans and provider organizations have seen this scenario play out from every angle: the member frustration, the regulatory compliance exposure, and the administrative burden and operational costs of managing provider directory information.
That’s the problem IHA and its partners set out to solve, and the infrastructure to address it is already in place.
A moving target
The core challenge is that provider data, including practice location, phone number, affiliations, and panel status, changes constantly. Physicians retire, relocate, join or leave practices, and update health plan contracts on an ongoing basis. Whether a provider is accepting new patients can vary by payer, line of business, and product within a single health plan’s portfolio. The scale of the problem is well documented. In examining directory entries for more than 40% of US physicians, inconsistencies were found in 81% of entries across 5 large national health insurers.i
The traditional mechanism for keeping directories current is the provider roster, a static data file that provider organizations submit to each contracted health plan. In concept, it’s a reasonable solution. In practice, it creates a significant administrative burden on both sides of the exchange.
Providers typically submit separate updates to 20 or more payers, each with different formats, data fields, and submission requirements. Meanwhile, health plans receive rosters from hundreds of provider organizations and must reconcile inconsistencies to try and maintain accurate and compliant directories.
The healthcare industry spends more than $2.1 billion annually to maintain provider data.ii Despite that investment, the Centers for Medicare & Medicaid Services (CMS) found that more than 45% of provider office locations in online directories contained at least one error.iii
Real-world consequences of inaccurate directory information
The downstream consequences of bad provider data extend across the healthcare system.
For patients, inaccurate directories create significant barriers to care. The impact is especially severe in behavioral health, where access is already challenging. A 2025 HHS Office of the Inspector General review found that 72% of inactive behavioral health providers listed in Medicare Advantage and Medicaid managed care plans should not have been included in those directories.iv For a member trying to access mental health or substance use support, working through a directory full of inaccurate listings is a barrier to care that can have serious consequences.
The member experience problem extends beyond behavioral health. A 2025 consumer survey found that 33% of provider directory users have encountered outdated or incorrect information when searching for care.v Each of these encounters carries costs, including increased customer service call volume, out-of-network claims, and eroded trust during open enrollment.
On the provider side, practices spend an average of $1,000 per month and roughly one full staff day per week managing provider directory submissions across payers.vi This reflects administrative overhead with no direct patient care benefit, driven by the current fragmented data exchange process.
Regulatory and financial exposure compounds the operational burden. Audit risk, enforcement actions, and potential liability from network misrepresentation allegations are real and increasing as the regulatory environment tightens.
SB 137 and provider directory accuracy
In response to the provider directory accuracy problem, California passed Senate Bill (SB) 137 in 2015, establishing a comprehensive state-level framework for provider directory accuracy. SB 137 set uniform standards for how frequently health plans must update their directories, what information must be included, and how plans must verify provider availability, with oversight from the Department of Managed Health Care (DMHC) and the California Department of Insurance.
SB 137 was a meaningful step forward. Recognizing that meeting directory standards required more than policy guidance, IHA worked collaboratively with DMHC and other industry stakeholders to develop a purpose-built solution. That collaboration shaped the Symphony Provider Directory, designed to help health plans and provider organizations meet SB 137 requirements. The ongoing relationship between IHA, DMHC, and industry stakeholders continues to inform how Symphony evolves to meet the changing needs of plans, providers, and regulators.
However, many health plans and provider organizations, especially smaller ones, have continued to struggle with the operational demands SB 137 places on them. As regulatory expectations tighten, plans and providers need the infrastructure and ongoing guidance to keep pace.
California’s solution and what’s ahead
Launched in 2019, IHA’s Symphony Provider Directory operates as California’s statewide hub for provider directory data. Symphony is designed to replace the web of roster submissions between individual provider organizations and health plans with a single, standardized provider data exchange process. Providers update their information once. Health plans access accurate, validated data through a shared infrastructure. Symphony seeks to remove the redundant, inconsistent, and time-consuming burden of managing dozens of separate roster relationships.
Symphony’s cloud-based platform has grown steadily since launch, with participation across health plans and provider organizations statewide. The next step is helping participating plans and providers fully retire the legacy roster processes many have continued running in parallel with Symphony.
Toward roster alignment and retirement
In early 2026, Symphony launched a dedicated ‘Roster Retirement Workgroup’ series to do the detailed, collaborative work of mapping what it will take for plans to retire legacy roster processes. The series brought together participants from multiple health plans, provider organizations, associations, and the DMHC. Over six sessions and multiple sub-group sessions, the team completed analysis of eight health plan rosters, reviewed current requirements, and identified which data elements across those rosters can be removed, combined, standardized, or are already a part of the Symphony data model. Each participating health plan was given an individualized action plan with specific recommendations for improving data standardization and reducing redundant roster requests. Final recommendations are being reviewed with health plans, DMHC, and other stakeholders to align on a path forward.
With Symphony, California is creating a more connected approach to provider data exchange and maintenance. This collaborative infrastructure will reduce duplication, improve accuracy, and support greater interoperability. In our next article, we’ll take a closer look at Symphony’s progress towards aligning, and ultimately retiring, legacy rosters.
Discover how Symphony is transforming the way organizations maintain accurate provider directory information here.
i https://jamanetwork.com/journals/jama/fullarticle/2802329
ii https://www.caqh.org/hubfs/43908627/drupal/explorations/defining-provider-data-white-paper.pdf
iv https://oig.hhs.gov/documents/evaluation/11234/OEI-02-23-00540-highlights.pdf
v https://www.ipsos.com/sites/default/files/ct/news/documents/2025-09/LexisNexis%20Survey%20Public%20Release%20Key%20Findings%20Ipsos.pdfvihttps://www.medicaleconomics.com/view/survey-us-physicians-pay-billions-annually-maintain-provider-directories
