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CMS is Requesting Feedback on Establishing the First, National Directory of Health Care Providers & Services

Have you ever tried to find an in-network doctor on your health plan member portal, found one, and called them – only to find out that they’re not actually in network? Or worse, gone to a doctor you thought was in network only to later get a bill and find out they weren’t in network?

This common, frustrating problem is on CMS’ radar and could affect CMS regulations down the road. In CMS’ ongoing work to support interoperability & prior authorization, increase access to care, and decrease clinical burden/provider abrasion – they have their sights set on establishing the first, national directory of health care providers and services.

What’s the challenge?

Currently, there is no central directory for providers and services. This fragmented system makes it challenging for patients to find up-to-date information on providers and to find providers who are in network. It’s also challenging for providers – who have to update multiple databases and follow the requirements for each database.

It’s cumbersome and tiresome to both patients and providers. This barrier to care negatively impacts healthcare, as easy to find, accurate provider and service information is critical to member and population health.

The future – an accurate directory of providers  

CMS is considering developing a directory that would be a ‘centralized data hub’ for all health care. This ‘National Directory of Healthcare Providers & Services’ (NDH) would include accurate data in a publicly accessible database, developed through streamlined information submission from providers.

What you need to know

CMS has released a Request for Information (RFI) seeking public feedback on the NDH concept. CMS wants to know if consolidating this data in a central repository would improve access to care and make it easier for patients to find, evaluate, and compare providers based on their unique needs – such as accessibility and languages spoken.

How to provide your feedback

CMS is seeking feedback to better understand current health care directories and information they should consider as they develop the NDH concept. CMS is particularly looking for public feedback on benefits, provider types, entities, data elements, priorities, and any potential risks and challenges.

The CMS RFI is open for 60 days. It ends December 6, 2022.

Learn more and submit your feedback on the NDH here:

About the Author

Maggie Brown has over 30 years of leadership experience in healthcare and insurance marketplace. Maggie transitioned from health plan management roles to implementing core business solutions for numerous health plans around the country. With the enactment of HIPAA, the Balanced Budget Act, and the Medicare Prescription Drug, Improvement and Modernization Act of 2003 she focused on how to ensure a health plan could implement key technology solutions, meeting the needs of their members, while being compliant in a rapidly changing regulatory environment. Maggie has led implementations for government programs at both new and established managed care companies. Maggie holds a Doctor of Religious Arts degree with a major in Pastoral Psychology.