By Norah Brennan, SVP of Product Development 

Commercial network management is evolving. What was once viewed primarily as a contracting function is now inseparable from the member experience. 

Members do not evaluate networks based on the number of signed agreements. They evaluate them based on whether they can schedule an appointment, whether a provider is truly in network, and whether the information they see online matches what they are told when they call. Employers measure performance in similar terms. Regulators increasingly do the same. 

From my perspective, leading product development at HealthAxis, modern network management requires more than better contracts. It requires disciplined data governance, operational rigor, and technology that connects provider data to every member touchpoint. 

The New Expectations 

Today’s expectations are clear. 

Members expect accurate directories, intuitive digital experiences, faster problem resolution, and consistent information across portals, call centers, and printed materials. 

Not only employers, but the providers themselves expect predictable performance, fewer escalations, and reduced billing or access disputes that disrupt employee and patient satisfaction. 

Regulators expect greater accountability for both accuracy and access. Directory accuracy and network adequacy are no longer passive compliance items. They are active oversight priorities. 

What “Modern” Looks Like in Practice 

Modern network management blends contracting discipline with strong operational and data foundations. 

In practical terms, that typically includes: 

• Structured provider data governance models with defined ownership, verification processes, and routine auditing 

• Automation for routine updates and exception handling to reduce manual error 

• Analytics tied to access and adequacy performance, not just contract volume 

• Tight integration between provider data, claims, and member service systems 

• Rapid change workflows to address network shifts, terminations, or policy updates without lag 

When these capabilities work together, the network becomes a living system rather than a static file that is updated periodically. 

The Operating Model Shift: From Projects to Continuous Operations 

One of the most important changes I see across forward-looking commercial plans is the shift from periodic cleanup projects to continuous operational management. 

Instead of treating directory accuracy as a quarterly initiative, high-performing organizations build ongoing measurement and accountability into their daily workflows. 

That includes: 

• Tracking defined directory accuracy indicators 

• Monitoring complaint trends and failed appointment reports 

• Shortening the time between issue detection and correction 

• Establishing clear ownership across contracting, provider relations, operations, and member services 

This shift requires cultural alignment as much as technical capability. It means recognizing that provider data is not just an operational asset. It is a core component of the member experience. 

Why This Matters Now 

Commercial competition increasingly centers on experience, not just pricing. Employers and members have more visibility into network performance than ever before. 

When a directory is inaccurate or a provider status is unclear, the impact is immediate. It can lead to delayed care, unexpected bills, escalations, and reputational risk. 

Conversely, when network information is accurate, integrated, and continuously maintained, plans build trust. Providers experience fewer administrative disruptions. Member service teams operate more efficiently. 

Modern network management is no longer a back-office function. It is the front door to the health plan experience. For commercial plans looking to differentiate on service and reliability, strengthening this foundation is not optional. It is strategic. 

Provider data accuracy is not a back-office housekeeping issue. In public programs, it is an access issue, a compliance issue, and often a trust issue. 

When directories are inaccurate, members cannot find care, service teams absorb the fallout, and plans face higher complaint volume and regulatory scrutiny. Research has shown that directory inaccuracies can persist over long periods, underscoring how difficult this problem is without disciplined processes and strong data controls. 

The Real-World Impact of Inaccurate Provider Data 

Inaccurate data drives: 

• Failed appointment attempts and delayed care 

• Higher call volume as members seek help finding in-network providers 

• Higher out-of-network utilization when members cannot locate available in-network options 

• Grievances, appeals, and potential enforcement actions 

Recent reporting on “ghost networks” in mental health directories illustrates how severe the consequences can be when directories fail members at scale, including findings of very high unusable listing rates in at least one state investigation. 

For members who already face barriers to care, including transportation limitations, language needs, or complex health conditions, inaccurate directory information can mean repeated outreach, extended wait times, and, in some cases, foregone treatment. For plans, these breakdowns quickly become operational strain and reputational risk. 

Why This Is Harder in Public Programs 

Public programs tend to have: 

• High member churn 

• Network changes tied to state policies and contracting 

• Higher need for language access and local provider availability 

• Frequent member questions about access and eligibility 

These dynamics create a constantly shifting environment. A provider who was accepting new patients last quarter may not be today. A clinic may change hours, locations, or participation status. In programs where eligibility can change month to month, members rely heavily on accurate, up-to-date information to make timely care decisions. 

That means provider data errors surface immediately in the member experience. What might be a minor data lag in a commercial environment can become a compliance exposure in Medicaid or other government-sponsored programs. 

A Practical Provider Data Accuracy Framework 

1) Define a Single Source of Truth 

Consolidate provider data governance, so downstream systems do not diverge. When claims systems, member portals, call center tools, and regulatory reports draw from different or loosely synchronized data sets, discrepancies multiply. Establishing a clearly governed master record reduces variation and supports consistent reporting. 

2) Validate on Ingestion 

If you accept provider updates from multiple sources, apply structured validation rules at intake. This can include format checks, credential verification steps, required field enforcement, and exception reason codes. Catching errors at the point of entry is significantly more effective than correcting them after they have propagated to member-facing systems. 

3) Implement Routine Verification with Measurable Standards 

Verification should be scheduled, role-owned, and auditable. Plans should define clear intervals for outreach and confirmation, track response rates, and monitor turnaround times for updates. Measurable standards help transform directory maintenance from an informal task into a repeatable operational process. 

4) Close the Loop with Member Services 

Member services teams often see directory issues before anyone else. Call driver analysis, complaint tracking, and escalation tagging can reveal patterns such as providers not accepting new patients or incorrect specialty listings. Feeding this insight back into network operations creates a faster correction cycle. 

5) Treat Provider Data as a Living Product 

Public program needs evolve. Networks expand, policy requirements shift, and access standards tighten. Provider data management should be built for continuous change, with defined ownership, performance metrics, and technology that supports configuration rather than manual rework. Periodic cleanups are not enough in a high-churn environment. 

Where AxisCore Comes In 

HealthAxis’s CAPS solution, AxisCore, supports provider data and network operations through standardized workflows, configurable validation rules, and centralized data management capabilities. By reducing manual touchpoints and strengthening governance, organizations can improve directory accuracy while maintaining flexibility to adapt to state-specific requirements and program changes. Learn more about AxisCore today.