Ghost networks have long plagued the healthcare system, creating barriers to care, frustrating patients, and challenging providers and insurers alike. These networks, filled with inaccurate or outdated provider data, hinder access to necessary services by listing healthcare professionals who are no longer practicing, not accepting new patients, or listed incorrectly as in-network. Addressing this pervasive issue is critical to ensuring members receive timely and appropriate care.
The introduction of the REAL Health Providers Act marks a significant step toward eradicating ghost networks. Spearheaded by U.S. Senators Michael Bennet, Thom Tillis, and Ron Wyden, this bipartisan legislation introduces strict requirements for Medicare Advantage plans to verify provider directory data every 90 days starting in 2026. Providers no longer in a network must be removed within five business days, and patients who receive care from inaccurately listed providers must only pay in-network rates. Annual accuracy analyses and public scoring of directories aim to hold health plans accountable and promote trust among members.
However, accurate directories are not just a regulatory necessity—they are essential for member satisfaction. Reliable provider data ensures that patients can find the care they need without unnecessary delays or frustration. Inaccurate directories often lead to wasted time and, worse, deferred care, which can result in escalating medical issues and increased healthcare costs. When patients have confidence in their health plan's directory, they are more likely to remain loyal, satisfied members.
A powerful example of the harm caused by ghost networks comes from the Yale Law & Policy Review, which found error rates as high as 98% in some Medicare Advantage directories. This data failure forced patients, particularly those seeking behavioral health services, to navigate a frustrating maze of inaccuracies. One patient’s caregiver reported giving up on finding an in-network psychiatrist due to the overwhelming time and effort required. It is stories such as these that illustrate the urgent need for accurate, trustworthy provider information.
HealthLink Dimensions has been a leader in solving the ghost network problem. With solutions like Provider Directory Advantage, HealthLink Dimensions offers tools to identify and correct inaccuracies while ensuring compliance with regulations like the No Surprises Act. Through real-time validation and a 4X-verification process, HealthLink Dimensions provides health plans with updated, accurate, and actionable data. These innovations not only meet compliance standards but also deliver significant value by enhancing member satisfaction and improving care outcomes.
In addition to correcting bad data, HealthLink Dimensions leverages its vast dataset to optimize engagement. By using Rx, Dx, Sx, and Px data, health plans, HealthLink Dimensions can target providers based on the specific conditions they treat, ensuring that directories are not only accurate but also clinically relevant. This precision reduces resource waste and boosts ROI while ensuring patients can easily access the care they need.
Technology-driven solutions like those offered by HealthLink Dimensions are critical in the fight against ghost networks. Manual verification methods are labor-intensive, prone to error, and insufficient for keeping pace with the ever-changing healthcare landscape. By harnessing automation, AI, and real-time updates, health plans can eliminate ghost networks and maintain directories that patients can rely on.
Accurate provider directories are more than a compliance requirement—they are a cornerstone of patient trust and satisfaction. By embracing solutions that prioritize data integrity, health plans can improve member experiences, foster loyalty, and ensure that patients connect with the care they need, when they need it. Together, we can eliminate ghost networks and build a healthcare system that works for everyone.
