Add-on to Blueprint
Find out what’s wrong in your provider directory before your members do.
Providers move, phones change and NPIs get deactivated, and nobody tells the plan. The Directory Audit checks every provider you list against public sources and gives your team a short list of what to fix.
What it checks, for every provider
Load your directory or roster as a spreadsheet, whatever the columns are called. Provider data only, no member data.
Is the NPI still active?
Each NPI against the national NPI Registry: active, not active, or no record at all.
Does it belong to this provider?
The name on the registry against the name in your directory.
Are the office and phone right?
The registry's practice location and number against your listing. Formatting differences are cleared on their own.
What changed?
The record's last update date, compared with your last audit, so you see who moved or changed something.
Are they excluded?
The OIG exclusion list, SAM.gov's exclusions and CMS's Medicare opt-outs. A name-only match is only ever marked as possible.
Does your pipeline agree?
Anyone your directory lists as active whose practice isn't in network in Blueprint.
Rules do the sorting, so your team works the short list
Every result records the rule, source and date behind it, so you can defend it. The rules never decide someone is excluded, and they never remove anyone.
Needs a person
Exclusions, inactive NPIs, an NPI that belongs to someone else, and listings your pipeline disagrees with. Each one shows the source and the next step.
Confirm with the practice
Addresses or phones that differ, and records that changed. Blueprint writes one note per practice, listing only what differs.
Low priority
A suite number that differs, or a very old record that may well still be right. Listed, with nothing to do today.
Cleared by the rules
Nothing found on the sources checked. One in 20 of these goes to a person as a spot check, so you keep testing the rules.
How to add it
Priced by network size. Ask us for a quote on your network.
Add it to Blueprint
Run it from your workspace whenever you want a fresh check. Each audit compares with the last one, so you see what changed.
Included in Blueprint Complete
Recurring audits come with Blueprint Complete, alongside gap analysis and the HSD export.
A one-time audit
Not on Blueprint yet? Send us your directory. We run the audit, review the results with you and hand you the report.
What it isn’t
- A CMS determination or accuracy score. It's a check for your team.
- Credential verification. It doesn't check licenses, DEA or board certification.
- Every list. State Medicaid exclusion lists aren't included yet.
- Continuous monitoring. Each audit is a dated check, and you decide how often to run it.
- A directory sync. Your team updates your directory from your own systems, and nothing is removed automatically.
NPI Registry data is self-reported by providers, so a difference is a question to ask, not proof of an error.
Why it matters now
- Medicare Advantage plans already have to keep directories current and attest to their accuracy each year.
- CMS has proposed verifying every 90 days and reporting an accuracy score, starting in contract year 2028. It isn’t final.
How to work with us
Want to see your own directory this way?
Walk into every leadership meeting with the answer, and give your team back the weeks they spend chasing paperwork.
Step 1
Schedule a 30-minute call
Bring a state and a filing date. We'll show you your own counties on CMS's rules and where the gaps would land.
Step 2
We set it up in about a week
Your counties and standards, your provider list, and a provider portal in your brand. Your team gets trained on your build.
Step 3
Your team runs the build
Providers sign and send their paperwork in one place, follow-ups go out on their own, and adequacy updates as practices join.