15.8%

of in-network providers require carrier audit

Includes 0.2% critical findings requiring immediate carrier review (Federal Exclusions & Deactivated NPIs)

Based on 41,940 providers scored across 5 validity dimensions using 10 data sources

Network Validity Findings

Data last refreshed: March 12, 2026 · Sources: Transparency in Coverage filings + federal datasets

Executive Summary

Provider directory accuracy is critical for patient access. Our validity engine scores 41,940 in-network providers across Colorado using five evidence dimensions — identity, licensure, activity, reachability, and network integrity. Key findings:

27,681 providers are verified active with strong evidence across all dimensions
7,636 providers are likely active with moderate evidence
6,507 providers need carrier review — mixed or insufficient evidence
82 providers are high risk — multiple dimensions show inactivity indicators
17 providers have critical compliance issues (deactivated NPIs, federal exclusions)
15 federally excluded providers are still listed in carrier networks — requires immediate carrier review

Key Takeaway

15.8% of providers listed as in-network show directory accuracy issues requiring carrier audit.0.2% have critical findings — federal exclusions or deactivated NPIs still listed in active networks — requiring immediate carrier review. Patients relying on these directories may face appointment delays, unexpected out-of-network billing, or inability to access care.

Provider Validity Distribution

How providers are classified across validity labels based on evidence from 10 data sources

Verified Active

27,681 (66.0%)

Likely Active

7,636 (18.2%)

Needs Review

6,507 (15.5%)

High Risk — Inactive

82 (0.2%)

Insufficient Evidence

17 (0.0%)

Compliance Violation

15 (0.0%)

Confirmed Invalid

2 (0.0%)

Critical Compliance Signals

Hard signals that automatically flag a provider for immediate carrier review

Federal Exclusions

OIG LEIE / SAM.gov — still listed in carrier networks

Deactivated NPIs

NPI deactivated in NPPES but still in directory

Validity Dimension Analysis

Each provider is scored across five validity dimensions (0.0–1.0). Average scores across all in-network providers:

0.75

Identity

NPI & NPPES status

0.84

Licensure

DORA & PECOS enrollment

0.81

Activity

Medicare billing evidence

0.60

Reachability

Address consistency

0.85

Integrity

Cross-carrier corroboration

Carrier Directory Accuracy

Provider verification status by carrier network (unique providers per parent carrier)

Directory accuracy varies significantly across carriers. Larger networks show review rates averaging 20.6%, while smaller networks average 6.3% — suggesting that network size alone does not correlate with directory quality.

Carrier	Providers	Verified	Needs Review	High Risk	Review Rate
Anthem Blue Cross Blue Shield	34,915	27,207	7,615	93	22.1%
▸UnitedHealthcare	30,830	24,322	6,427	81	21.1%
▸Kaiser Permanente	31,102	25,313	5,667	122	18.6%
Cigna	10,291	9,414	866	11	8.5%
Aetna	3,342	3,203	135	4	4.2%

Critical Compliance Findings by Carrier

Carriers with federal exclusions or deactivated NPIs in active network listings (unique providers)

Carrier	Federal Exclusions	Deactivated NPIs	High Risk Inactive
▸Kaiser Permanente	11	5	106
▸UnitedHealthcare	4	2	75
Anthem Blue Cross Blue Shield	2	3	88
Cigna	0	2	9
Aetna	0	1	3

6C-3 Service Minimum Effectiveness

Comparing providers in DOI-submitted TiC files (with 6C-3 service minimum filtering) against providers from federal or carrier-direct filings.

DOI 6C-341,149 providers

Avg Composite Score

0.77

Avg Activity Score

0.81

Active: 84.4%Flagged: 0.2%

Federal / Carrier Direct791 providers

Avg Composite Score

0.71

Avg Activity Score

0.75

Active: 76.1%Flagged: 0.3%

Providers in DOI-submitted TiC files (with 6C-3 service minimum) score 9.1% higher on average than providers from federal filings alone, suggesting the service minimum filter improves directory quality.

Methodology

We cross-reference nine independent federal and state data sources to score provider directory validity across five evidence dimensions:

Identity — NPI status, NPPES record freshness, enumeration date
Licensure — Colorado DORA license verification (3-tier match), PECOS enrollment
Activity — Medicare utilization evidence, CMS Care Compare listings
Reachability — Address corroboration across NPPES, Care Compare, carrier filings
Integrity — Cross-carrier network corroboration via TiC filings

Hard signals — deactivated NPIs and federal exclusions (OIG LEIE / SAM.gov) — automatically override dimension scoring and flag the provider for immediate carrier review.

For full methodology details, see the Methodology page.

Specialty Breakdown

Specialty	Providers	Avg Score	Flagged Providers	Review Rate
Pharmacy	5	0.72	5	100.0%
Chiropractor / Optometrist	5	0.64	5	100.0%
Genetic Counselor	62	0.71	56	90.3%
Dietitian/Nutritionist	366	0.72	322	88.0%
Behavioral Analyst	659	0.69	563	85.4%
Nursing	38	0.70	31	81.6%
Physician	18	0.67	14	77.8%
Behavior Technician	183	0.70	141	77.0%
Pharmacy	13	0.71	9	69.2%
Clinical Lab Technologist	9	0.67	6	66.7%
Audiologist / Speech-Language	9	0.74	6	66.7%
Physical Therapist	6	0.69	4	66.7%
Clinical Lab Technologist	17	0.68	11	64.7%
Nursing	16	0.69	10	62.5%
Pharmacy	5	0.74	3	60.0%
Physician	5	0.72	3	60.0%
Physician	9	0.72	5	55.6%
Nursing	9	0.70	5	55.6%
Midwife (Certified Nurse Midwife)	195	0.70	101	51.8%
Nurse Practitioner / PA	9	0.71	4	44.4%
Physician	9	0.74	4	44.4%
Physical Therapist	36	0.73	15	41.7%
Audiologist / Speech-Language	5	0.73	2	40.0%
Clinical Lab Technologist	5	0.70	2	40.0%
Physician	15	0.74	6	40.0%
Respiratory Therapist	5	0.72	2	40.0%
Physician	5	0.78	2	40.0%
Physician	5	0.67	2	40.0%
Physical Therapist	8	0.67	3	37.5%
Podiatrist	8	0.71	3	37.5%
Nurse Practitioner / PA	17	0.73	6	35.3%
Ambulance / Transportation	12	0.70	4	33.3%
Physician	18	0.75	6	33.3%
Physical Therapist	36	0.74	12	33.3%
Audiologist / Speech-Language	13	0.69	4	30.8%
Physician	10	0.74	3	30.0%
Speech-Language Pathologist	669	0.70	198	29.6%
Audiologist / Speech-Language	14	0.72	4	28.6%
Physician	7	0.73	2	28.6%
Physician	14	0.78	4	28.6%
Physical Therapist	11	0.73	3	27.3%
General Acute Care Hospital	11	0.76	3	27.3%
Audiologist	208	0.76	53	25.5%
Chiropractor	483	0.76	123	25.5%
Physician	8	0.79	2	25.0%
Physician	8	0.73	2	25.0%
Physician Assistant	8	0.79	2	25.0%
Podiatrist	12	0.75	3	25.0%
Physician	8	0.74	2	25.0%
Physician	12	0.75	3	25.0%
Physical Therapist	8	0.69	2	25.0%
Occupational Therapy Assistant	137	0.75	33	24.1%
Certified Registered Nurse Anesthetist	356	0.79	84	23.6%
Physician	17	0.74	4	23.5%
Occupational Therapist	508	0.71	118	23.2%
Pediatric Hematology-Oncology	56	0.74	13	23.2%
Clinical Psychologist	612	0.73	137	22.4%
Physician	9	0.78	2	22.2%
Nurse Practitioner / PA	9	0.75	2	22.2%
Physician	9	0.77	2	22.2%
Podiatrist	23	0.78	5	21.7%
Physician Assistant - Certified	244	0.76	53	21.7%
Physical Therapist	2,165	0.75	465	21.5%
Respiratory Therapist	28	0.73	6	21.4%
Physician	14	0.79	3	21.4%
Chiropractor / Optometrist	24	0.77	5	20.8%
Counselor	572	0.75	116	20.3%
Community/Behavioral Health Center	5	0.77	1	20.0%
Podiatrist	15	0.74	3	20.0%
Physician	10	0.83	2	20.0%
Physician	10	0.75	2	20.0%
Pharmacist	5	0.74	1	20.0%
Podiatrist	5	0.73	1	20.0%
Pathology - Anatomic & Clinical	120	0.77	23	19.2%
Physician	21	0.74	4	19.0%
Social Worker	462	0.75	88	19.0%
Physician	21	0.75	4	19.0%
Clinical Laboratory Technologist	37	0.72	7	18.9%
Medical Oncology	37	0.80	7	18.9%
Nurse Practitioner - Neonatal	70	0.77	13	18.6%
Physician	22	0.79	4	18.2%
Physician	22	0.75	4	18.2%
Clinical Lab Technologist	11	0.70	2	18.2%
Physician	11	0.74	2	18.2%
Physician	11	0.77	2	18.2%
Respiratory Therapist	34	0.75	6	17.6%
Psychologist	368	0.75	64	17.4%
Emergency Medicine	774	0.79	130	16.8%
Anesthesiologist Assistant	173	0.78	29	16.8%
Physician	6	0.76	1	16.7%
Physician	6	0.73	1	16.7%
Physician	6	0.81	1	16.7%
Physician	6	0.75	1	16.7%
Physician	6	0.80	1	16.7%
Physician	12	0.73	2	16.7%
Physician	6	0.81	1	16.7%
Physical Therapist	24	0.73	4	16.7%
Physician	6	0.82	1	16.7%
Mental Health Counselor	2,300	0.75	374	16.3%
Physician	19	0.75	3	15.8%
Physician	32	0.71	5	15.6%
Acupuncturist	200	0.76	31	15.5%
Physician	13	0.75	2	15.4%
Thoracic Surgery (Cardiothoracic)	39	0.79	6	15.4%
Neuropsychologist	52	0.77	8	15.4%
Registered Nurse - Psychiatric/Mental Health	105	0.74	16	15.2%
Podiatrist	46	0.81	7	15.2%
Physician	33	0.77	5	15.2%
Physician	20	0.77	3	15.0%
Maternal & Fetal Medicine	34	0.75	5	14.7%
Nurse Practitioner - Pediatrics	338	0.74	49	14.5%
Psychiatry	529	0.77	76	14.4%
Podiatrist	7	0.81	1	14.3%
Physician	7	0.78	1	14.3%
Audiologist / Speech-Language	7	0.74	1	14.3%
Physical Therapist	7	0.78	1	14.3%
Physician	7	0.81	1	14.3%
Nurse Practitioner / PA	7	0.77	1	14.3%
Neonatal-Perinatal Medicine	63	0.74	9	14.3%
1223D0004X	7	0.71	1	14.3%
Anesthesiology	711	0.79	100	14.1%
Occupational Therapist - Pediatrics	94	0.71	13	13.8%
Vascular & Interventional Radiology	44	0.81	6	13.6%
Psychologist - Child/Adolescent	81	0.75	11	13.6%
Physician	15	0.80	2	13.3%
Nuclear Radiology	30	0.83	4	13.3%
Clinical Social Worker	2,511	0.76	333	13.3%
Family Medicine	1,432	0.80	186	13.0%
Clinical Nurse Specialist	180	0.77	23	12.8%
Optometrist	594	0.80	75	12.6%
Audiologist	40	0.72	5	12.5%
Podiatrist	8	0.74	1	12.5%
Physician	8	0.84	1	12.5%
Radiology	57	0.82	7	12.3%
Endodontics	41	0.73	5	12.2%
Anesthesiology - Pediatric	41	0.76	5	12.2%
Pediatric Allergy/Immunology	42	0.75	5	11.9%
Nurse Practitioner - Women's Health	126	0.78	15	11.9%
Pediatric Cardiology	84	0.74	10	11.9%
Diagnostic Radiology	455	0.81	54	11.9%
Physician	17	0.82	2	11.8%
Marriage & Family Therapist	362	0.76	42	11.6%
Endocrinology, Diabetes & Metabolism	78	0.81	9	11.5%
Podiatrist - Surgery	70	0.82	8	11.4%
1223P0221X	105	0.74	12	11.4%
Student Health Center	1,107	0.80	124	11.2%
Physician Assistant - Medical	634	0.79	71	11.2%
Addiction (Substance Use Disorder) Counselor	674	0.76	75	11.1%
Podiatrist	18	0.75	2	11.1%
1223P0700X	9	0.72	1	11.1%
Periodontics	37	0.72	4	10.8%
Internal Medicine	1,568	0.81	166	10.6%
Psychologist - Counseling	76	0.76	8	10.5%
Physician Assistant	1,943	0.80	204	10.5%
Nurse Practitioner / PA	39	0.76	4	10.3%
Physical Medicine & Rehabilitation	168	0.80	17	10.1%
Physician	10	0.82	1	10.0%
Gynecologic Oncology	30	0.79	3	10.0%
Physician	10	0.82	1	10.0%
Physician	10	0.77	1	10.0%
Chiropractor / Optometrist	10	0.79	1	10.0%
Registered Nurse	612	0.77	61	10.0%
1223X0400X	114	0.73	11	9.6%
Nurse Practitioner - Acute Care	180	0.81	17	9.4%
General Dentistry	801	0.73	75	9.4%
Cardiovascular Disease	174	0.81	16	9.2%
Nurse Practitioner / PA	11	0.79	1	9.1%
Physician	22	0.82	2	9.1%
Physician	11	0.75	1	9.1%
Emergency Medicine - Sports Medicine	44	0.78	4	9.1%
Physician	11	0.82	1	9.1%
Pediatrics	923	0.76	83	9.0%
Infectious Disease	113	0.81	10	8.8%
Neuroradiology	34	0.81	3	8.8%
Pulmonary Disease	114	0.81	10	8.8%
Nurse Practitioner - Family	1,313	0.80	115	8.8%
Oral & Maxillofacial Surgery	80	0.74	7	8.8%
Allergy & Immunology	46	0.81	4	8.7%
Nurse Practitioner - Psychiatric/Mental Health	417	0.80	36	8.6%
Professional Counselor	1,976	0.77	170	8.6%
Nurse Practitioner	559	0.80	47	8.4%
Nurse Practitioner - Gerontology	96	0.81	8	8.3%
Nurse Practitioner - Adult Health	252	0.80	21	8.3%
Nurse Practitioner / PA	12	0.79	1	8.3%
Dentist	726	0.73	60	8.3%
Surgery	268	0.81	22	8.2%
General Practice	49	0.79	4	8.2%
Physical Therapist	49	0.72	4	8.2%
Obstetrics & Gynecology	515	0.79	42	8.2%
Dermatology	174	0.82	14	8.0%
Nurse Practitioner / PA	25	0.77	2	8.0%
Physician	25	0.82	2	8.0%
Physician	25	0.76	2	8.0%
Neurology	254	0.82	20	7.9%
Midwife	39	0.78	3	7.7%
Gastroenterology	156	0.82	12	7.7%
Physician	26	0.82	2	7.7%
Hematology & Oncology	105	0.81	8	7.6%
Anesthesiology - Pain Medicine	27	0.82	2	7.4%
Neurology - Neuromuscular Medicine	41	0.77	3	7.3%
Urology	110	0.82	8	7.3%
Ophthalmology	201	0.82	14	7.0%
Physician Assistant - Surgical	293	0.81	20	6.8%
Physician	15	0.83	1	6.7%
Physician	15	0.83	1	6.7%
Pharmacist	16	0.73	1	6.3%
Physical Therapist Assistant	48	0.73	3	6.3%
Physician	16	0.84	1	6.3%
Otolaryngology	112	0.81	7	6.3%
Physician	16	0.81	1	6.3%
Nurse Practitioner - Obstetrics & Gynecology	32	0.79	2	6.3%
Nephrology	97	0.81	6	6.2%
Hospitalist	229	0.82	14	6.1%
Sports Medicine (Orthopedic)	51	0.81	3	5.9%
Nurse Practitioner - Primary Care	86	0.81	5	5.8%
Physician	19	0.80	1	5.3%
Orthopedic Surgery	293	0.82	15	5.1%
Child & Adolescent Psychiatry	102	0.76	5	4.9%
Pharmacist	484	0.73	23	4.8%
Physician	22	0.82	1	4.5%
Physician	24	0.74	1	4.2%
Physical Therapist	24	0.79	1	4.2%
Neurological Surgery	103	0.81	4	3.9%
Physician	26	0.83	1	3.8%
Geriatric Medicine	57	0.81	2	3.5%
Physician	29	0.83	1	3.4%
Plastic Surgery	36	0.80	1	2.8%
Pediatric Gastroenterology	38	0.75	1	2.6%
Pediatric Endocrinology	52	0.76	1	1.9%
Critical Care Medicine	108	0.83	2	1.9%
Rheumatology	64	0.82	1	1.6%
Nurse Practitioner / PA	9	0.77	0	0.0%
Physician	7	0.84	0	0.0%
Physician	5	0.81	0	0.0%
Physician	7	0.74	0	0.0%
Physician	11	0.84	0	0.0%
Physician	5	0.78	0	0.0%
Physician	26	0.84	0	0.0%
Physician	7	0.79	0	0.0%
Physician	5	0.84	0	0.0%
Physician	7	0.85	0	0.0%
Physician	20	0.74	0	0.0%
Physician	10	0.78	0	0.0%
Physician	7	0.76	0	0.0%
Physician	12	0.82	0	0.0%
Physician	6	0.80	0	0.0%
Physician	10	0.75	0	0.0%
Physician	11	0.76	0	0.0%
Physician	9	0.80	0	0.0%
Physician	6	0.78	0	0.0%
Physician	7	0.83	0	0.0%
Physician	5	0.80	0	0.0%
Physician	6	0.86	0	0.0%
Physician	15	0.83	0	0.0%
Physician	17	0.83	0	0.0%
Physician	5	0.77	0	0.0%
Physician	13	0.86	0	0.0%
Physician	8	0.79	0	0.0%
Physical Therapist	6	0.78	0	0.0%
Physician	6	0.86	0	0.0%
Physical Therapist	6	0.81	0	0.0%
Physician	20	0.83	0	0.0%
Physician	13	0.80	0	0.0%
Physician	14	0.81	0	0.0%
Physician	5	0.80	0	0.0%
Physician	5	0.80	0	0.0%
Physical Therapist	8	0.74	0	0.0%
Pharmacist	5	0.72	0	0.0%
Clinical Lab Technologist	6	0.79	0	0.0%
Podiatrist	14	0.79	0	0.0%
Podiatrist	13	0.78	0	0.0%
Podiatrist	7	0.75	0	0.0%
Podiatrist	11	0.81	0	0.0%
Podiatrist	8	0.78	0	0.0%
Podiatrist	7	0.77	0	0.0%
Nurse Practitioner / PA	11	0.81	0	0.0%
Physician	7	0.83	0	0.0%
Nurse Practitioner / PA	5	0.78	0	0.0%
1223D0001X	7	0.74	0	0.0%
Physician	5	0.78	0	0.0%
Physician	5	0.79	0	0.0%

Limitations and Caveats

This analysis uses publicly available data and cannot determine whether a provider is currently seeing patients.
No Medicare billing does not mean zero clinical activity — providers may bill through other payers.
NPPES freshness reflects self-reported updates, which providers may neglect without ceasing practice.
Address mismatches may reflect legitimate multi-site practices rather than inaccurate listings.
Coverage is limited to Colorado in-network providers from carrier transparency files.
Validity scores reflect evidence availability, not provider quality — “Needs Review” indicates mixed evidence, not confirmed inactivity.

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