This is a hands-on lesson. Set aside two hours, work through every plan you participate in, and record what you find. Most practices doing this for the first time find at least one significant error per plan.
Search as a patient, not as a provider
The single most important instruction. Do not log into a provider portal and read your own record, because that shows you what you filed, not what patients see.
Instead use the public member-facing directory, the one a patient opens when checking coverage. Search the way they would:
- Search by specialty and location, not by your practice name. This tests whether you are findable at all.
- Then search by your practice name, then by each clinician name.
- Filter as a patient would, by accepting new patients, by distance, by specialty.
- Test each plan and product separately, since a practice can be in-network on one product and absent from another.
The specialty-and-location search is the revealing one. Practices are often correctly listed but unfindable, because the specialty or taxonomy filed does not match the filter patients use.
The checklist per plan
For every plan, and every clinician within it, verify:
- Do you appear at all in a specialty-plus-location search?
- Practice name, matching your canonical record.
- Address, including suite. Watch for a billing or mailing address here.
- Phone number. Then actually dial it and confirm where it rings. This is the step everyone omits, and it is the one that finds the billing-line problem.
- Every location you operate, not just one.
- Every current clinician listed, and no departed ones.
- Specialty and taxonomy, matching how patients filter.
- Accepting new patients status, and whether it is honest.
- Languages spoken.
- Telehealth availability, where offered.
- Accessibility details.
- Website link, where the directory supports one.
Record results in a simple grid: plan down the side, fields across the top, and a note of every discrepancy.
Call your own listing
Do this for every plan. Dial the number exactly as published and note what happens: does it ring, who answers, can they book an appointment, or does it reach billing, a fax tone, or nothing at all.
Practices are routinely shocked by this exercise. A number filed during credentialing three years ago frequently reaches a department that cannot schedule, which means every insured patient who found you through that plan hit a dead end.
Submitting corrections
Corrections flow through the credentialing chain rather than a public edit form:
- Update your shared credentialing profile first, since many payers pull from it. Chapter three covers this.
- Attest promptly, and do not let attestation lapse.
- Submit corrections directly to each payer through their provider maintenance process as well, since not all of them refresh promptly.
- Correct NPI records in parallel, because stale NPI data regenerates errors.
- Use your provider representative for anything that will not correct through the standard route.
- Keep written confirmation of every submission with its date.
Then verify the correction landed
The step that distinguishes an audit from a gesture. Diarise a re-check for eight to twelve weeks after submitting, and search the public directory again as a patient.
Corrections frequently do not take. A submission is not a fix, and without a re-check you will assume it worked and discover otherwise a year later.
Making it routine
- Full audit twice a year, at minimum.
- Immediate audit after any move, rename, phone change, or clinician change.
- Immediate audit after joining or leaving a plan.
- Keep the grid, so you can see which payers are reliably wrong and escalate with them.
- Log everything in your change log with dates.
Marketing to referring providers is next.