PROVIDER DIRECTORY VERIFICATION

Provider directory verification, done continuously and documented for a regulator

ProviderONE delivers multi-channel outreach, NPI validation, and audit-ready reporting — so your directory reflects what’s actually true.

The challenge

Provider data decays faster than most plans can track it

Providers change locations, leave networks, and stop accepting new patients constantly — and federal directory-accuracy rules are inconsistent between CMS and the states, with more changing every year.

Inaccurate directories create downstream costs in claims, credentialing delays, and member access to care — and they’re increasingly a compliance finding on their own.

What ProviderONE delivers

1

Multi-channel provider outreach

Direct outreach to confirm what NPPES and self-reported data cannot tell you.

2

NPI & hospital affiliation verification

Validation against NPPES plus confirmed practice locations and affiliations.

3

Audit-ready reporting & integration

Structured data delivery with a documented trail for CMS and state review.

How it works

01
Data onboarding

Load your current directory and network roster.

02
Multi-channel outreach

Providers are contacted to confirm current data.

03
Validation & capture

Responses are validated against NPPES and captured.

04
Reporting & integration

Clean data flows back into your systems, with a trail.

05
Ongoing monitoring

Verification repeats on a cadence, not once a year.

Regulatory coverage

Built around the requirements that govern directory accuracy.

CMS provider directory rules State Medicaid requirements NPPES NPI validation Medicare Advantage standards Hospital affiliation verification HIPAA

Verified data, not just API access.

Most competitors sell API access to NPPES data. ProviderONE sells outreach that confirms what NPPES cannot tell you — documented, so it holds up under a regulator’s review.

20+ yr
Public sector healthcare compliance
Multi-channel
Outreach across phone, fax, and web
100%
Audit trail on every record
Ongoing
Continuous, not a one-time sweep

See ProviderONE on your data.

Schedule a demo

See MemberONE or ProviderONE on a 30-minute call.