The U.S. Centers for Medicare & Medicaid Services (CMS) is considering a major initiative: the creation of the first national health care provider directory. Announced recently, this proposal could have a profound impact on the behavioral health industry, which has long struggled with fragmentation and inconsistent provider information. CMS is positioning the national health care provider directory as a tool to make it easier for patients to find up-to-date information on providers within their networks while simultaneously reducing reporting burdens on health care providers.
A centralized national health care provider directory could serve as a single, authoritative source of provider information, improving accuracy in patient searches and helping payers maintain current provider networks. CMS envisions integrating the directory with modern technology, including Application Programming Interfaces (APIs) that would allow payers to update data seamlessly. This capability would not only streamline reporting but also foster better collaboration between payers and providers, potentially enabling more coordinated care across the health care system.
To gather feedback, CMS has issued a Request for Information (RFI) to the public, inviting stakeholders to share insights and suggestions about the potential structure and utility of such a directory. The RFI is open until December 6, 2022, giving providers, payers, and patient advocacy groups an opportunity to shape the development of the national health care provider directory, a tool that could transform access to care nationwide.
“Easy access to accurate and useful provider directory information is critical for patients trying to find health care that best meets their individualized needs and preferences,” CMS Administrator Chiquita Brooks-LaSure said. “CMS is seeking comment on how a national health care provider directory could better serve patients and reduce unnecessary burden placed on providers to maintain dozens of separate directories. We look forward to hearing from our stakeholders on the need for a single source for this information for the entire health sector.”
The Challenge of Fragmented Behavioral Health Networks
Behavioral health care has long been marked by complexity and fragmentation. Patients seeking services—whether mental health therapy, psychiatric care, or substance use treatment—often encounter multiple layers of obstacles, from unclear insurance coverage to incomplete provider directories. Even when patients are insured, navigating behavioral health networks can be confusing and time-consuming.
Historically, payers have struggled to maintain accurate records of their behavioral health networks. Research published in Health Affairs highlights the magnitude of this problem: in Oregon’s Medicaid directory, 67.4% of mental health prescribers and 59% of mental health non-prescribers were “phantom” providers—clinicians listed in the directory who did not actually accept Medicaid patients. These discrepancies not only frustrate patients but can delay access to care, sometimes with serious consequences for individuals in urgent need of treatment.
Inaccurate directories aren’t just a Medicaid problem; they affect commercially insured patients as well. Many private insurance plans list providers who may have retired, moved, or stopped accepting new patients, creating confusion for individuals trying to access care. This lack of reliable information underscores the need for a centralized system like a national health care provider directory that can deliver accurate, real-time data on provider availability.
How a National Directory Could Improve Access
A national health care provider directory could significantly enhance patient access to behavioral health care by consolidating provider information into a single, centralized platform. Patients would no longer need to navigate multiple websites or call numerous offices to verify provider availability. Instead, they could rely on a single source for accurate, up-to-date information on in-network providers.
Such a system could also incorporate advanced features like API integration, enabling payers to update provider information automatically. This would reduce administrative burdens on providers, who currently must report their availability and credentials to multiple insurance plans individually. The result could be more accurate directories, faster updates, and a smoother experience for both patients and clinicians.
Additionally, a national health care provider directory could foster improved collaboration between payers and providers. By providing a consistent source of information, payers could better manage their networks, and providers could ensure their availability is accurately reflected across insurance platforms. For patients, this means more predictable access to care and fewer barriers to connecting with the right behavioral health professional.
Digital Tools Helping to Bridge the Gap
Some payers are already exploring digital solutions to address the challenges posed by fragmented behavioral health networks. In August, CareFirst BlueCross BlueShield partnered with mental health startup Headway to help members locate in-network behavioral health providers more easily.
“It’s a fragmented cottage industry that’s hard for members to navigate,” said Brian Wheeler, VP of provider collaboration and network transformation at CareFirst. “We wanted to organize it in a way that was a win for members and a win for our practitioners.”
Digital tools like this can improve patient experience by offering searchable databases, online appointment booking, and real-time verification of provider availability. These platforms can also collect feedback from patients and providers, further refining the quality and accuracy of the directory. While such tools are helpful, they are still fragmented themselves, with each insurer or platform maintaining its own system. A national health care provider directory could unify these efforts, creating a standardized framework accessible to all patients, providers, and payers.
Implications for Behavioral Health
Behavioral health care stands to gain particularly from a national health care provider directory. Access to mental health services is often hindered by provider shortages, administrative complexity, and fragmented networks. Accurate, centralized information could help patients find providers who are not only in-network but also equipped to meet their specific needs, whether for therapy, psychiatric care, or substance use treatment.
For Medicaid patients, who have historically faced the most difficulty in locating providers, a centralized directory could be transformative. By ensuring that listings reflect actual availability, patients would have a clearer path to care, and payers could more effectively manage their networks. For private insurers, the directory could reduce the occurrence of “phantom” providers and improve overall transparency in behavioral health access.
Moreover, such a system could encourage innovation and competition among providers. By making provider information more accessible, patients can make informed choices based on availability, location, specialty, and patient reviews. This transparency could drive improvements in quality and patient satisfaction across the behavioral health sector.
Conclusion
Behavioral health care is complex, fragmented, and often difficult for patients to navigate. CMS’s proposed national health care provider directory could simplify this process by offering a single, centralized platform with accurate, up-to-date information. By reducing administrative burdens, improving collaboration between payers and providers, and enhancing patient access, the initiative has the potential to transform the behavioral health landscape.
Stakeholder feedback will play a critical role in shaping this directory, ensuring it meets the needs of patients, providers, and payers alike. As the health care industry looks toward greater transparency and accessibility, a national health care provider directory could become an essential tool for connecting individuals with the care they need—efficiently, reliably, and equitably.
