This is How Your Members Feel

A core part of our work at Maven One is helping health plans validate their provider directories. That often means digging into the raw data and evaluating it for completeness, validity, and accuracy. But no matter how pristine a record looks on paper, sometimes you still have to pick up the phone and call the provider to see if the data actually holds up.

In a recent “secret shopper” audit, our analyst dialed the number listed for what appeared to be a Mental Health Counseling practice in Virginia. Instead, she reached a kind woman in New Jersey—on her personal cell phone. When asked whether she was affiliated with that medical group, the woman replied, “Honey, I’m affiliated with my cat.”

To that good-natured cat mom (and her patient feline), please accept our sincere apologies for interrupting your afternoon.

But this isn’t an isolated oddity—it’s emblematic of a much larger problem across the health care industry. Inaccurate directory data doesn’t trickle into your system; it floods in. In fact, CMS audits consistently show that more than half of the provider entries they review contain at least one error.

What may seem like a mild annoyance—calling a number and getting someone’s personal cell—can feel very different when you’re the one in need of care. If you’re unwell and under stress, the last thing you want is to spend precious time chasing down the right office or practitioner.

• Eroded Member Trust: Frustrated members are less likely to engage with their network proactively.

• Provider Frustration: Every misdirected call or visit wastes providers’ time and diminishes their willingness to cooperate.

• Regulatory & Financial Risk: Inaccurate directories can lead to No Surprises Act violations, CMS penalties, and impaired network adequacy reporting.

While there’s no silver bullet, here are practical measures any health plan can start today:

• Monthly Roster Refreshes
  Request up-to-date provider rosters at least once a month—and immediately after any staffing change.

• Automated Change Processing
  Build a workflow that automatically ingests adds, terms, and updates—so your directory reflects reality in near real time.

• CVA Framework Checks
  Layer completeness, validity, and accuracy checks into your ETL or data-validation pipeline.

• Secret Shopper Audits
  Periodically call a random sample of directory entries to spot-check what your members actually encounter.

None of these are trivial—and they require sustained commitment. But unless we connect real people with accurate information, all the data in the world won’t help anyone reach the care they need.

If you’d like to understand exactly how your directory performs from a member’s perspective, we’d love to help. Maven One can run your data through our CVA framework, pinpoint the biggest trouble spots, and recommend a targeted improvement plan.

And if you’re not quite ready for a full consulting engagement, consider our premium subscription: every month we publish in-depth deep dives and toolkits to help you level up your provider data game.

Ready to bridge the gap between clean data and real-world connections? Let’s get started.