MA Plan Finder: Draft Technical Guidance and Timeline Explainer
On November 7, CMS released a memo explaining what data Medicare Advantage carriers need to submit so that their directory information appears
Author: Ron Urwongse
MA Plan Finder: A Dress Rehearsal for National Provider Directory
On September 19, 2025, CMS issued a Final Rule requiring Medicare Advantage (MA) plans to submit provider directory data to CMS in
SMART Scheduling Links at the HL7 FHIR Connectathon
Special thanks to Adam Culbertson, Cooper Thompson, Josh Mandel, and Brandon LaRue for fact checking historical details and providing general input into
National Provider Directory Accuracy: July 2025 Report
Despite investing millions in master data management, data cleanup, and syndicating data through APIs and online directories, payers often lack an understanding
CMS Health Tech Ecosystem RFI: National Directory Comments
In its recent Request for Information (RFI) on the Health Tech Ecosystem, CMS posed questions about the value and feasibility of a
How will the CMS National Directory affect health plans?
CMS announced on June 3, 2025 plans to build a National Directory of Healthcare (NDH). While the directory’s long-term vision includes both
Notes from the CMS and ASTP/ONC RFI Meeting in Washington, DC
I attended the CMS and ASTP/ONC RFI meeting, which drew 300+ participants from across the healthcare industry. Participants included tech vendors, providers,
VA and CMS: Fixing Provider Directories Together
In the past week, the federal government released two Requests for Information (RFIs): one from CMS seeking input on the Health Technology Ecosystem and
Empowering Patient Choice with Payer and Provider Data
Special thanks to Aneesh Chopra, Chief Strategy Officer at Arcadia; Ryan Howells, Principal at Leavitt Partners; Eric Ellsworth, Director of Health Data
Payer Provider Directories + Appointment Scheduling
This post was co-authored with Aneesh Chopra, Chief Strategy Officer at Arcadia and first U.S. Chief Technology Officer under the Obama administration,
Mental Health Provider Directories: The Rising Risk of Litigation
Last week, a class action lawsuit was filed in the Southern District of New York against Anthem Blue Cross and Blue Shield,
CMS Announces National Directory for Healthcare Pilot in Oklahoma
Yesterday at Health Datapalooza, CMS announced its intent to pilot key components of a National Directory of Healthcare in the state of
Using Provider Directory APIs to identify errors in plan directories
“One potentially promising method is to use data analytics to compare health plans’ directories, many of which are available in machine-readable formats
HHS report considers the merits of centralized provider directories
In December 2023 the Office of Behavioral Health, Disability, and Aging Policy (within the US Department of Health and Human Services) published
State of Provider Directory APIs 2024
Background and Purpose of Analysis In July 2021, CMS required payers with CMS-regulated health plans to publish Provider Directory APIs. In the 3 years
Provider Directory API’s Supporting Role in the 2024 CMS Interop Rule
Key Takeaways: Re-Cap of the 2024 Rule Our previous post included a summary of the 2024 CMS Interoperability and Prior Authorization Final
A Review of the 2024 CMS Interoperability Rule through the Lens of Directory Use Cases
Yesterday, 13 months after proposing it, CMS finalized its Interoperability and Prior Authorization Rule. As CMS worked towards publishing this rule, payers,
The REAL Health Providers Act
Last week, the Requiring Enhanced and Accurate Lists (REAL) of Health Providers Act was introduced by Senators Wyden D-Ore., Bennet D-Colo., and
How payers can think about competition as network and price transparency expands
Regulatory Requirements on Network and Price Transparency Transparency-related federal rules are causing a seismic shift in the healthcare industry, compelling payers to
Payers are switching Provider Directory API vendors
Two years after the effective date of the CMS Final Rule on Patient Access and Interoperability, payers are reassessing their Provider Directory
Using Payer APIs to Improve Mental Health Networks
In our last article, we explored mental health ‘ghost’ networks as discussed in the May 3rd Senate Finance Committee hearing. We summarized
Understanding Mental Health ‘Ghost’ Networks
This is the first of a two-part series on mental health ghost networks. In the first post, we will assess the information
How many payer contracts do providers have?
Knowing the number of payers that providers contract with is important for a few reasons. Reason 1: It is a proxy for
What a good developer experience looks like: VA Lighthouse
In our previous post, we reviewed the status of payer provider directory APIs and learned that some payers take a compliance-only mindset
Provider Directory APIs: Beyond a Compliance-Only Mindset
State of Payer Compliance on Provider Directory APIs It has been 18 months since the July 2021 effective date of the CMS
Responses to the CMS RFI on National Healthcare Directory
In response to CMS’s RFI on a National Healthcare Directory (responses were due Thurs 12/6/2022), over 600 responses were submitted (around 50%
A Review of the CMS RFI on National Healthcare Directory
Executive Summary: CMS describes a National Healthcare Directory that will streamline provider data collection and promote interoperability. Years of industry engagement have
Health equity and languages spoken
The Need for Linguistically-Appropriate Services On April 20, 2022, CMS released an action plan that establishes health equity as a ‘first pillar’
The Importance of Health Plan Information and Identity
Defacto Health has been reviewing health insurers’ Provider Directory APIs in terms of availability, issues, and use cases for almost a year
Using Provider Directory APIs to assess provider network size
When CMS issued its requirement for payers to publish Provider Directory APIs, it contemplated use cases such as in-network provider search and
Analysis of top 50 payers’ Provider Directory APIs
In our previous post, we reviewed aggregate statistics on payers publishing provider directory APIs in the first six months of enforcement of
Payer Compliance: Provider Directory APIs in the first six months since CMS Final Rule enforcement
The CMS Final Rule on Interoperability and Patient Access requires payers to publish provider directory APIs and has been enforceable since July
What indoor healthcare wayfinding taught me about the governance of practice location data
With the convergence of payer and provider interoperability, there is growing interest in how data sourced directly from EHRs could support provider
Epic partners with Mapquest: EHR and location awareness
Last week, Epic announced it is partnering with Mapquest to ‘enable location services within its EHR system’. Three questions come to mind
Prevalence of centralized appointment phone numbers in health plan provider directories
This is the first of a series of posts analyzing payer-published provider directory data sets mandated by the CMS Final Rule. Defacto
Hire healthcare data to do a job
Applying Job-to-be-done Theory to Healthcare Data I believe that when a customer purchases a product, they are “hiring” that product to do