Your Network Has to Prove Itself, Over and Over
Health plans are always re-demonstrating that members can reach care within CMS time, distance, and ratio standards. State Medicaid agencies set and publicly post their own quantitative adequacy standards across at least seven provider types, and they enforce them through audits and public reporting.
Provider directories make the job harder. CMS reviews of Medicare Advantage directories from 2017 to 2021 found that only 29% to 47% of sampled provider records were fully accurate1. In a 2025 consumer survey, 33% of people using a provider directory ran into outdated or incorrect information.2
These "ghost networks" mean possible compliance findings, a member who can't reach the doctor your directory promised, and a Star Ratings and CAHPS hit.
That's why health plans are turning to Salesforce Health Cloud, Data 360, and MuleSoft. With the right implementation partner, the whole network lifecycle runs on one platform, from the moment a gap appears to the moment a credentialed provider shows up in your directory.
Challenge
Closing an adequacy gap takes five disconnected processes, so gaps linger and directory errors surface in audits and member complaints.
Solution
Health Cloud, Data 360, and MuleSoft connect adequacy analysis, recruiting, contracting, credentialing, and directory updates on one platform.
Results
Network teams prove adequacy on demand, credentialing stays current, and members reach the providers your directory lists.
The Challenge
Closing one network gap means identifying it, recruiting a provider, contracting, credentialing, and updating the directory. Different teams own each step and different systems hold each piece.
Manual Handoffs
Every handoff is a chance for status to get lost or an error to creep in. Gaps stay open longer than they should and often surface in a compliance review or a member complaint first.
Credentialing by Hand
Primary-source verification against the NPI Registry, state licensing boards, and CMS databases is tough to track manually. It's even tougher to keep current as provider statuses change.
Ghost Networks
Directories updated separately, and often late, become inaccurate. A 2025 review of behavioral health networks across Medicare Advantage and Medicaid managed care found that 72% of "inactive" listed providers shouldn't have been listed at all.3
The Solution
We connect every stage of the network lifecycle so one update flows through everywhere it needs to go.
Gaps Found Automatically
Data 360 analyzes claims, member addresses, and provider locations to calculate adequacy against time and distance, ratio, and wait-time standards. Specific gaps get flagged by geography and specialty, continuously, before a filing deadline forces the issue.
Recruiting and Contracting as One Motion
Identified gaps feed directly into targeted recruiting campaigns aimed at the provider types and regions you need, built on Penrod's Precision Marketing framework. Flow-driven contracting workflows track each provider from first outreach to signed agreement, with automated task assignments and status anyone can check.
Continuous Credentialing
MuleSoft connects credentialing to the NPI Registry, state boards, and CMS databases for ongoing primary-source verification. A lapsed license or sanction surfaces immediately.
A Directory That Stays Accurate
Health Cloud's provider data model, with Provider, Practitioner, and network objects, holds the full network lifecycle in one place. Contracted providers move through automated onboarding, and the directory pulls from the same system that manages each provider's status. Ongoing monitoring catches and corrects errors before members find them.
The Results
Adequacy You Can Prove Any Day of the Year
When adequacy runs continuously, your network team stops recalculating by hand every renewal cycle. Gaps show up early, by specialty and by county, while there's still time to recruit.
Recruiting and contracting move faster because nobody has to chase status over email. Credentialing stays current, so a lapsed license gets caught right away.
Your directory finally stays accurate. That means members reach the providers you list, which protects your Star Ratings and CAHPS performance. And, your compliance team stops worrying about data.
Ready to See It Against Your Own Network?
Your next audit or member complaint shouldn't be how you find a gap. Let's look at your current process, find the gaps it's missing, and talk through how fast you could close them.
Adequacy on Demand
Continuous Credentialing
Accurate Directories
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Need adequacy on demand, continuous credentialing, accurate directories, and a partner who can help?
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