Prognosis Consulting/ Services/ Provider Directory Hygiene
Pillar I · Performance

Directory errors
cost you claims
silently.

A provider listed as inactive in one payer's system, wrong NPI on file with another, CAQH attestation lapsed — each one is a denial waiting to happen. We cross-reference your roster against Medicare PECOS, GA Medicaid, NPPES, CAQH, and eight major commercial payers, and deliver a certificate documenting exactly what we found.

View Pricing → Payer Coverage
$295 Snapshot
8-Payer Audit $895
Maintenance from $99/mo
Directory Audit — Sample Results
Medicare PECOS ✓ Active
NPPES NPI Registry ✓ Current
Georgia Medicaid ⚠ Expired Address
Aetna Georgia ✓ Active
BCBS of Georgia ✗ Inactive — No Record
Cigna ✓ Active
UnitedHealthcare ✓ Active
CAQH ProView ⚠ Attestation Lapsed 94 days
⚠ Action Required — 2 Discrepancies
BCBS GA silent drop detected. CAQH lapse exceeds 90-day threshold — payers using CAQH may stop routing claims. Both require remediation before next billing cycle.
Prognosis Consulting · Directory Audit 8 Payers + NPPES + CAQH
Why This Matters

Directory errors
don't announce themselves.

Most practices discover a directory problem when claims start denying with reason codes that reference network status or provider enrollment — not a letter, not a warning, just a denial queue that takes weeks to trace back to a lapsed attestation or a silent payer drop.

Payer directories are maintained by the payer, not by the provider. When a payer's internal processes generate a status change — a network termination, an address mismatch, a failed auto-renewal — the provider is often the last to know. CAQH attestation lapses are the most common trigger: most commercial payers pull credentialing data from CAQH, and a lapsed attestation can cascade across eight payers at once.

01
Silent Network Terminations

Payers periodically purge inactive providers from their directories without individual notification. A provider who hasn't seen patients covered by a given payer in 12 months may be dropped without warning — and their next claim from a patient with that coverage will deny out-of-network.

02
CAQH Attestation Cascade

CAQH ProView requires re-attestation every 120 days. Most commercial payers pull credentialing data from CAQH; a lapsed attestation can affect Aetna, Cigna, UHC, Humana, and others simultaneously. The cascade is invisible until claims start returning.

03
PECOS Revalidation Gaps

Medicare PECOS requires revalidation every five years. Providers who miss the revalidation window have their billing privileges deactivated — often after receiving a single notice to an outdated address. A deactivated billing privilege cannot be backdated; all claims submitted during the gap are non-payable.

04
NPI / Address Mismatches

Practice addresses, group NPIs, and rendering provider NPIs frequently fall out of sync across payer systems after a location move, a name change, or a group reorganization. A billing NPI that doesn't match the payer's directory entry is a technical denial regardless of whether the claim is otherwise clean.

Payer Coverage

Every payer your
practice actually bills.

The Directory Audit tier covers eight major payers plus NPPES and CAQH. The Multi-Site Audit expands to twelve payers with multi-state support. All tiers include PECOS revalidation status as a standard check.

Federal · Always Included

Medicare PECOS

Provider Enrollment, Chain, and Ownership System. Active enrollment status, revalidation due date, billing privilege status. The single most consequential directory check for any Medicare-billing practice.

Federal · Always Included

NPPES NPI Registry

National Provider Identifier verification — address, specialty taxonomy, group affiliation. NPI mismatches between the practice billing system and NPPES are a common source of claim routing failures.

State · Always Included

Georgia Medicaid (DCH)

Georgia Department of Community Health provider directory. Enrollment status, address currency, service area verification. Required for any practice billing Georgia Medicaid or CMO populations.

Credentialing · Always Included

CAQH ProView

Attestation status and days since last re-attestation. CAQH lapse is the single highest-frequency directory issue in commercial payer credentialing. The 120-day cycle catches most practices unprepared.

Commercial · Audit Tier

Aetna Georgia

Network status, effective date, product line enrollment (HMO, PPO, EPO). Aetna Georgia pulls credentialing directly from CAQH — a lapsed attestation here surfaces immediately in Aetna's directory.

Commercial · Audit Tier

BCBS of Georgia

Blue Cross Blue Shield of Georgia network status. BCBS GA is historically the highest-volume commercial payer for most Georgia primary care practices and the most common source of silent network termination findings in our audits.

Commercial · Audit Tier

Cigna / UnitedHealthcare

Network status, effective dates, product-specific credentialing flags. UHC and Cigna are the second and third largest commercial payers by Georgia market share. Both require independent directory verification from CAQH data.

Commercial · Audit Tier

Humana + One Additional

Humana network status included in the standard eight-payer audit. The eighth payer slot is client-selected — Anthem, Ambetter, Alliant, or any other commercial carrier relevant to your practice's payer mix.

Pricing

Point-in-time audits
and ongoing maintenance.

One-time audits produce a certificate and remediation list. Maintenance subscriptions keep your directory current on a defined cadence — the right model for practices where provider turnover or multi-payer complexity makes one-time audits insufficient.

One-Time · Entry
Snapshot
1 payer · up to 10 providers
$295
  • Single-payer directory verification
  • Up to 10 providers
  • Discrepancy list with action items
  • Branded certificate on clear result
  • 5 business day delivery
Request →
One-Time · Standard
Directory Audit
8 payers + NPPES + CAQH · up to 10 providers
$895
  • 8 major commercial payers checked
  • NPPES and CAQH attestation status
  • PECOS revalidation due date
  • Up to 10 providers
  • Discrepancy list with remediation steps
  • Branded compliance certificate
  • 7 business day delivery
Request →
One-Time · Group
Multi-Site Audit
12 payers · up to 30 providers · debrief call
$2,195
  • 12 payers — full matrix + client-selected
  • Up to 30 providers
  • Multi-state directory support
  • Extended remediation action list
  • Branded certificate
  • 30-minute findings debrief call
  • 10 business day delivery
Request →
Urgent · Single Issue
Emergency Correction
1 payer · 1 provider · 5-day turnaround
$495
  • Single-provider, single-payer urgent issue
  • Silent drop, wrong NPI, incorrect effective date
  • 5 business day turnaround guaranteed
  • Remediation documentation included
  • Ideal for active denial situations
Request →
Directory Maintenance — Ongoing Subscriptions
Quarterly or monthly re-checks with automatic CAQH attestation reminders and PECOS revalidation tracking. The right model for practices where the one-time audit isn't enough.
Solo · 1 Provider
Solo Maintenance
$99
per month
  • Quarterly re-check of 8 payers + NPPES
  • CAQH attestation reminder at 90 days
  • Monthly status report
  • Quarterly refreshed certificate
Small Practice · Up to 5
Practice Maintenance
$249
per month
  • Quarterly re-check of 12 payers + NPPES + CAQH
  • CAQH attestation calendar per provider
  • PECOS revalidation tracking
  • Monthly status report + quarterly certificate
Group · Up to 15
Group Maintenance
$499
per month
  • Monthly re-check · full payer matrix
  • License renewal calendar per provider
  • PECOS revalidation alerts
  • Monthly certificate + quarterly review call
The Deliverable

Certificate and
remediation list.

Every audit tier produces a branded certificate documenting the payers checked, the result per provider per payer, and a remediation action list for any discrepancy found. The certificate is formatted for placement in a compliance file, credentialing binder, or payer audit response.

✓
Payer-by-Payer Status Grid

Every provider's status across every payer checked — active, inactive, address mismatch, CAQH lapsed, PECOS revalidation due — presented in a grid format that makes discrepancies immediately visible.

✓
Remediation Action List

For each discrepancy, a specific remediation action — who contacts which payer, what documentation is required, what the resolution timeline typically looks like. Not a recommendation to "contact your payer." An actual action list.

✓
CAQH Attestation Calendar

Standard and Group audit tiers include a per-provider CAQH attestation calendar showing the current attestation date, the 120-day window, and the next re-attestation due date — so you don't have to track it manually.

✓
Branded Compliance Certificate

Prognosis Consulting–issued certificate documenting audit date, payers checked, providers reviewed, and overall result. Clear or Discrepancies Found — formatted for credentialing files and payer audit responses.

Prognosis Consulting · Directory Services
Provider Directory Hygiene
Audit Certificate
Providers Audited
8
Payers Checked
10
Discrepancies Found
2
Overall Status
Review
Finding Summary
BCBS Georgia · Provider 3 Silent Drop Detected
CAQH ProView · Provider 5 Lapsed 94 Days
Medicare PECOS · All Providers Active — Revalidation Current
Aetna / UHC / Cigna / Humana All Active
NPPES NPI Verification All Current
Prognosis Consulting · Audit Date: May 2026 8-Payer Standard
Request an Audit

Find the errors
before the denials do.

Submit a request and we'll confirm scope, provider count, and payer list. The Snapshot is designed to turn around in 5 business days; a full 8-payer audit delivers in 7. Maintenance subscriptions start the month after sign-up.

Bundle with Prognosis
→ Add LEIE Screening — $99/month → Add Coding Audit — from $495
Request a Directory Audit

Or email hello@prognosisconsulting.com · Response within 1 business day