Some questions need more than a database lookup.
Two things about a listed clinician can be settled from a federal file. Everything else in a directory row has historically needed someone to pick up a phone.
The part no registry answers
A directory row is a promise: this clinician, at this address, on this number, will see your members. Whether a registration has been cancelled and whether someone is federally excluded are matters of public record. The rest is not.
- Do they still practise here?
- Does this number reach them?
- Are they accepting new patients?
- Is this affiliation current?
- Is the specialty right?
The traditional answer is a calling campaign, which is expensive enough that CMS's own directory review reached 108 providers per plan, in four specialties, once. That is the constraint the verification layer exists to remove.
A ladder, not a call centre
Each rung is more expensive and more intrusive than the one above it, so the agents stop at the first one that settles the question. Most records never reach the phone.
01 RESEARCH
Reads the rest of the network
Authoritative and corroborating sources, including every other payer directory that lists the same clinician. Another plan having already corrected the same row is independent confirmation, and it costs nobody a phone call.
02 EMAIL
Asks the practice
Where the sources disagree, it writes to the practice, handles the reply, and records what came back as evidence with a date on it.
03 VOICE
Calls when nobody writes back
It phones the listed number. Whether anyone answers, and what they say, is itself evidence about the number you publish.
04 EVIDENCE
Hands back a reviewable answer
Sources, responses and a confidence, assembled into something a person can check. Where the confidence does not clear, it escalates to a person rather than guessing.
What we will not claim for it
The two federal checks run at national scale today and are asserted outright. The verification ladder is how we intend to settle the rest, and we would rather say where it has and has not run than describe a roadmap in the present tense.
Where a check is not yet running nationally, the coverage table says so. A finding that came from an agent carries what the agent did, who it contacted and when, in the same evidence trail as everything else. And no finding we publish carries an NPI or a clinician's name, because one lookup turns an NPI into a person. How the whole system fits together