Healthcare operations · Case study
HHS OIG: verify provider listings
Turn inactive-provider findings into verified listings, approved corrections and a dated recheck queue.
Solution design based on public sources. Reported results are attributed to their original deployments.
By OneShot · Updated
Read the solution ↓What the workflow produces
Directory correction record- Listing
- Provider identity, location and plan participation.
- Attestation
- Respondent, date and supporting confirmation.
- Approved correction
- Reviewer decision and publication evidence.
- Next check
- Review date or unresolved contact task.
The documented problem
HHS OIG’s October 2025 review examined behavioral-health networks in 60 Medicare Advantage and Medicaid managed-care plans. On average, 55% of listed Medicare Advantage providers delivered no services to the plan’s enrollees in 2023.
Inactivity alone does not establish an inaccurate listing. OIG also found that many inactive providers should not have been listed. The operational task is to verify location and participation, collect the evidence and correct the plan’s record.
- HHS OIG report OEI-02-23-00540Primary source · Checked 2026-10-04
The OneShot solution
Provider directory verification with confirmed corrections
Keep the plan’s provider listings supported by current participation and location evidence, with corrections tracked to publication.
- 01
Prioritize the review
Load the plan’s listings and reported discrepancies. Check current public practice information, keeping potential identity or location mismatches separate from confirmed changes.
- Local Business Resolve
- Web Read
- Provider directory updates
- 02
Confirm with the practice
Identify the verification purpose and ask about location, plan participation and new-patient availability. Record the respondent and date; an unanswered call remains unverified.
- Voice call time
- Call analysis
- Provider directory updates
- 03
Get the correction attested
Send the proposed correction for practice confirmation. Route conflicting answers and fax-only responses to the reviewer for verification.
- Email send
- Email Inbox
- Fax
- Provider directory updates
- 04
Publish and recheck
Have the plan reviewer approve the change, confirm it reached the directory and set the next review date. Escalate access gaps to network contracting.
What counts as complete
The listing is verified or its approved correction is confirmed in the directory, with the next review scheduled.
Decisions and exceptions
- Unanswered calls do not justify removing a provider.
- Conflicting participation statements go to network operations.
- Fax-only responses go to the directory team for document handling and verification.
What to measure
- Listings with current evidence
- Correction publication time
- Unverified backlog
- Repeat discrepancies
Establish the baseline and review period before launch. Compare completed cases, unresolved work and reviewer corrections against the same scope.
The agent’s tool basket
OneShot gives its agents the tools to analyze records, communicate, research and act on authorized business data. The platform carries the workflow from the first action through to the recorded result.
Provider directory updates
Connect provider attestations and the plan's directory correction queue.
Workflow pricing
Scope the full workflow around your volume, business systems and required outcome.
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