The hidden data problem costing physicians time, referrals and patients

A patient calls three “in-network” specialists off a payer directory before finding one who's actually taking new patients. A newly hired physician sits for 90 to 120 days unable to bill because a credentialing file stalled somewhere between two mismatched databases. A prior authorization gets kicked back because a health plan's system has the wrong tax ID on file for a practice that's been open for a decade. Different scenes, same root cause: the data that's supposed to describe who a physician is, where they practice and whether they're actually available keeps breaking down before it reaches the people who need it.

New research commissioned by identity-management vendor Verato and fielded independently by Sage Growth Partners in the second quarter of 2026 puts numbers behind what physicians already feel. Sage surveyed 101 health system leaders and 50 health plan leaders, most of them VP-level or higher, and found that 85% of health systems and 78% of health plans agree that accurate, timely provider data is essential to hitting their strategic goals. Yet only 12% of either group rates their own data quality as excellent. Nearly nine in 10 health systems (88%) say inaccurate or incomplete provider data has a negative effect on their ability to execute strategy, and 78% of health plans report the same.

Ghost networks aren’t a glitch — they’re the norm

For physicians, the clearest symptom of this breakdown shows up in referrals that go nowhere. Trevor Colhoun and Kolby Nance told Medical Economics in August that ghost networks in behavioral health have become the norm rather than the exception: a 2025 federal investigation found 55% of behavioral health providers listed in sampled Medicare Advantage directories were inactive, and 28% were inactive in Medicaid managed care listings — providers who hadn’t delivered a single service under that plan in a year. “A physician who identifies a mental health condition and hands a patient a referral list is, in reality, simply turning the individual over to a scavenger hunt,” Colhoun and Nance wrote. “Patients in need will be calling providers who no longer accept the plan, have no openings or don’t return calls. Every dead end is not only disheartening but also adds to the delay.”

“Our number one priority is improving the inaccuracies in our directory,” a director of provider data at a regional Blue Cross Blue Shield plan told Sage Growth Partners, adding that the problem is getting more urgent as it draws more public scrutiny.

The Sage/Verato data helps explain why that keeps happening. Health system and health plan leaders overwhelmingly say clean, unified data is critical to expanding access to care — 83% of health systems named it a top use case — but only 42% of health systems and just 32% of health plans call themselves very or extremely effective at actually using their data that way. The gap between what organizations know they need and what they’ve built is, functionally, the same gap a patient hits when a referral number rings and rings.

It isn’t only a Medicare Advantage or behavioral health problem. Across the board, 92% of health systems and 98% of health plans in the survey say they encounter provider data inaccuracies at least monthly — many several times a week. Fewer than three in 10 health systems (28%) have a fully implemented, continuously maintained “golden record” — a single trusted source of truth for provider information — and for health plans that figure is 36%.

Why AI isn’t fixing this — and may be exposing it

Health systems and health plans are pouring money into AI, with 78% of health systems and 70% of health plans naming it their top technology investment priority over the next one to three years, according to the survey. The assumption is that automation will smooth over data problems that manual processes couldn’t. Madaket Health CEO Megan Schmidt told Medical Economics in May that AI is exposing rather than fixing payer data problems: “Machine learning models can identify anomalies, prioritize exceptions or accelerate certain workflows, but they cannot establish a trusted provider record where one does not exist. If the same physician appears differently across systems, AI may process the inconsistency faster, but it does not resolve the underlying governance issue.”

Schmidt was direct about who ends up paying for that gap: “That may sound like a payer operations issue, far removed from the daily pressures facing physicians. It is not. When health plan systems contain outdated or conflicting provider information, the consequences often fall directly on medical practices. A mismatched tax ID or inaccurate network affiliation can delay claims, trigger denials, slow onboarding and force staff into unnecessary follow-up with payers.”

That framing lines up closely with what health system and health plan executives told Sage Growth Partners. Survey respondents pointed to revenue cycle management and claims denials as a top use case for clean provider data (82% of health systems), but only 41% say their organization currently uses data well for that purpose. One chief technology officer at an academic medical center, quoted in the report, said organizations that build “a genuine, continuously maintained source of truth” over the next two to three years will have an advantage that compounds.

The credentialing bottleneck physicians feel directly

Provider data problems don’t stay confined to payer operations; they show up at the physician’s own desk. BELAY CEO Tricia Sciortino told Medical Economics in July that a 2026 survey of clinically inactive physicians found administrative hassle and job stress were each cited by 45% of doctors who left clinical practice early — ahead of unrealistic patient demands or diminished professional satisfaction. Sciortino described what that workload does to a solo or small-group practice without dedicated billing or credentialing staff: “When a physician spends the evening on data entry, the practice is paying its highest-earning hour to do its lowest-leverage work. Put plainly, the doctor becomes the most expensive administrator in the building. Every hour spent reconciling the books or chasing an unpaid invoice is an hour not spent seeing a patient, closing a chart before dark or simply stepping away from the desk long enough to keep from burning out.”

The Sage/Verato survey doesn’t focus specifically on credentialing, but its findings on data fragmentation explain why that workload never shrinks. Multiple stakeholders — IT, medical staff services, physician relations, compliance — all touch the same provider record without a shared source of truth, so every credentialing update, license renewal and affiliation change has to be re-entered and re-verified system by system.

What health systems and plans say they’d do differently

The research isn’t all diagnosis. Nearly all respondents — 95% of health systems and 96% of health plans — believe that implementing better provider-data technology would let them eliminate at least one existing system, and roughly half in each group think they could cut three to five. The report’s authors lay out a three-step sequence for getting there: resolve each provider into a single accurate identity first, keep core attributes like location and specialty continuously refreshed second, and only then layer in higher-order data — clinical activity, referral patterns, compliance history — that turns a directory into something strategically useful. Skipping straight to analytics or AI without fixing identity first, the report argues, just reproduces the same fragmentation in a more sophisticated wrapper.

For physicians, none of this is abstract. It’s the difference between a referral that connects a patient to care within days and one that dead-ends in a disconnected phone number. It’s the difference between a new hire billing on day 60 instead of day 150. And it’s the difference between a claim that pays because the system has the right information the first time, instead of one that gets kicked back, appealed and eventually paid anyway — after a staff member spent an afternoon proving what should never have been in question. Health systems and health plans increasingly say they know this. Whether 2026 is the year enough of them act on it remains the open question physicians are still living with every day.