Accurate provider data is the foundation of a functioning healthcare system. Yet in 2025, we're still grappling with a costly and largely invisible crisis: bad provider data. From delayed care to surprise billing, the effects ripple through every part of the patient experience and the revenue cycle.
At the recent Reuters Digital Health conference, Sarah Ahmad, CEO of CAQH, called attention to the consequences of outdated, incomplete, or incorrect provider data. Her warning was clear: we cannot fix healthcare’s administrative complexity without fixing the quality of provider information.
Inaccurate Data Is a Patient Safety Issue
It might seem like a minor detail—maybe a misspelled address or an outdated phone number—but the impact can be serious.
- Patients show up to the wrong clinic, only to find their provider no longer practices there.
- Wrong specialty listings mean patients are scheduled with the wrong type of provider, delaying critical diagnoses.
- Network status errors result in patients seeing out-of-network doctors by mistake, leading to unexpected medical bills or denied claims.
These aren't edge cases—they’re everyday occurrences that erode trust in the healthcare system and harm patient outcomes.
The Systemic Cost of Bad Data
For payers, bad data isn’t just inconvenient—it’s expensive.
- Manual verification of provider details consumes administrative resources that could be used elsewhere.
- CMS penalties loom over insurers with inaccurate directories, especially when such errors hinder access to care or result in surprise billing.
- Claim denials and resubmissions skyrocket when directory inaccuracies lead to incorrect coding or network mismatches.
- Provider directories require constant upkeep, yet few systems are designed to maintain them efficiently.
Ultimately, bad data compounds the very administrative waste the industry is trying to eliminate—fueling the $250 billion in excess costs that organizations like McKinsey and CAQH aim to address.
Why It’s So Hard to Get Provider Data Right
The reality is, most providers don’t enter their data just once. They’re asked to fill out redundant forms across multiple systems—from health plans and credentialing bodies to EHRs and insurance directories.
This fragmented process leads to:
- Fatigue and human error from overburdened office staff
- Stale data when updates don’t propagate across systems
- Multiple versions of the truth, making reconciliation nearly impossible
CAQH estimates that around 75–80% of U.S. providers already use their centralized portal. But usage alone isn't enough—data quality depends on design, incentives, and verification.
CAQH’s New Approach to Data Integrity
To address the issue, CAQH is rolling out a three-pronged strategy:
- Front-End Simplicity
They’re redesigning the portal to make it easier and more intuitive for providers to input data correctly the first time. Fewer clicks. Better guidance. Smarter defaults. - Real-Time Validation
AI and third-party data sources now cross-reference provider entries in real time to detect errors or inconsistencies before they go live. - Industry Collaboration
Ultimately, data accuracy is not just a tech challenge—it’s a shared responsibility. Providers, payers, EHR vendors, and regulators all need to work from the same playbook.
This new framework highlights a fundamental shift: accuracy must be proactive, not reactive.
What SuperDial Brings to the Table
At SuperDial, we’ve seen firsthand how data integrity impacts every corner of the revenue cycle. Our platform is built to validate, synchronize, and automate the flow of provider and insurance data at scale.
Here’s how SuperDial helps clean up the mess:
- Automated insurance verification ensures that provider credentials, network affiliations, and plan details are current before a claim ever goes out.
- AI-powered call automation flags inconsistent or missing data during eligibility checks—cutting down on denials and rework.
- Real-time sync with payer databases and scheduling systems prevents the propagation of outdated provider info across systems.
We’re not just a software platform—we’re a compliance partner helping health systems and MSOs avoid penalties, optimize their directories, and reduce call center burden.
A Clear Path From Insight to Impact
Here’s how the industry can move forward, based on the priorities shared at Reuters Digital Health:
Final Thought: Bad Data Is a Fixable Problem
Provider data isn't just a spreadsheet problem—it’s a patient care problem, a financial problem, and a trust problem. But it’s also a fixable one.
With centralized infrastructure, better verification tools, and intelligent automation platforms like SuperDial, the healthcare industry has the tools to fix this. The challenge now is getting everyone to use them—and use them well.
The future of healthcare starts with something deceptively simple: getting the data right.
Need help cleaning up your provider and insurance data workflows?
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About the Author
Harry is passionate about the power of language to make complex systems like health insurance simpler and fairer. He received his BA in English from Williams College and his MFA in Creative Writing from The University of Alabama. In his spare time, he is writing a book of short stories called You Must Relax.