7 Ways to Stay Audit-Ready with Provider Data Cleansing

In today’s highly regulated healthcare environment, health plans can’t afford to overlook the accuracy and integrity of their provider directories. The stakes are high: inaccurate directories can lead to regulatory penalties, member dissatisfaction, network access issues, and costly public audits.

Fortunately, modern data cleansing and verification services can help health plans proactively manage these risks. In this post, we’ll break down how these services work, what audit-readiness looks like for health plans, and why Perspecta is a trusted partner in getting it done.

Why Audit Readiness for Provider Data Matters
Provider directories are subject to strict federal, state, and accreditation regulations. The Centers for Medicare & Medicaid Services (CMS) requires Medicare Advantage plans to review and update their provider directories at least every 90 days. Additionally, state regulators and accreditation bodies like NCQA and URAC have their own stringent data accuracy standards.

Non-compliance can result in regulatory fines, CMS corrective action plans, accreditation jeopardy, negative audit findings, member access issues and dissatisfaction and more.

Audit readiness isn’t optional, it’s operational insurance.

7 Ways Data Cleansing & Verification Services Ensure Audit Readiness

1. Identify & Correct Inaccuracies: Routine data cleansing detects and resolves issues like outdated phone numbers, duplicate or conflicting records, missing specialties and inactive or retired providers. Modern services like Perspecta’s data verification tools cleanse provider data down to the attribute level, correcting errors while preserving data lineage — critical for traceability and audit defense.
   
   
2. Verify Against Authoritative Sources: Verification services cross-reference provider data with trusted, authoritative sources including CAQH, State licensure boards, NPPES and more. Various solutions even enable real-time feedback loops with providers to verify data directly, mitigating ghost networks and bad data. 
   
   
3. Track & Documents Changes: Audit readiness depends on clear, comprehensive documentation of how and when provider data was updated and where that information came from. Often, data cleansing services maintain a detailed audit trail for every attribute-level edit, source verification, provider attestation, change timestamps and more. This level of documentation is essential for demonstrating due diligence during CMS, NCQA, or state audits. 
   
   
4. Ensure Directory Completeness: An incomplete directory is as risky as an inaccurate one. Cleansing services perform completeness checks to confirm every required data element is present and up to date. Regular completeness reviews prevent gaps that could trigger audit findings or limit member access to care.
   
   
5. Monitor for Regulatory Requirements: Regulations aren’t static, and compliance requires vigilant oversight. Leading data services align their processes with evolving CMS requirements, state-specific laws (some states mandate 48-hours for changes), NCQA and URAC accreditation standards. This proactive monitoring ensures provider directories remain aligned with current rules. A CMS audit guide confirms provider directories must be updated every 90 days and that MA plans must maintain consistent verification processes to remain in compliance. 
   
   
6. Proactive Error Reporting: Most cleansing and verification services include automated discrepancy reporting flagging data anomalies, incomplete or conflicting records and records nearing verification deadlines. This allows health plans to correct issues before they trigger audit findings, thus improving both operational performance and data health.
   
   
7. Support for Compliance Documentation: Many services generate compliance-ready reports and summaries detailing cleansing and verification activities. These packages offer regulators evidence of routine directory management, consistent data verification, documented corrective actions and change histories and attestations. The CMS Part C/D Validation Manual emphasizes the importance of maintaining detailed audit trails, standardized processes, and third-party verification audits to protect payer compliance.

What Should Be On Your Compliance Checklist? 

Activity	Audit Readiness Benefit
Attribute-level cleansing & lineage	Evidence of accurate, traceable data changes
Frequent provider attestation	Demonstrates compliance with CMS 90 day verification requirements
Cross source and automated verification	Validates accuracy against authoritative external sources
Robust audit trails & reports	Enables fast, defensible responses during audits
Alignment with CMS/state standards	Ensures directories meet required regulations and avoid penalties

A well-executed data cleansing and verification program gives health plans operational confidence, protects accreditation, and ensures audit-readiness on demand.

Why Choose Perspecta for Data Cleansing & Verification?
When it comes to audit readiness, not all data services are created equal and Perspecta’s Provider Data Cleansing & Verification services deliver more than accuracy, they deliver operational confidence. 

Our attribute-level cleansing ensures every provider data point is accurate, traceable, and defensible. We perform automated validations against over 5,000 authoritative sources, including NPPES, CAQH, and state licensing boards, delivering verified, trusted records at scale.

With real-time provider outreach and attestation management, we help health plans maintain continuous compliance with CMS’s 90-day requirements, while comprehensive audit trails and reporting packages support fast, defensible audit responses.

Perspecta’s data cleansing services aren’t just regulatory-ready, they’re operationally efficient.

• Achieve 95%+ data accuracy rates, tracked via intuitive programmatic dashboards
• Cleanse over 1 million provider records weekly per client
• Reduce or eliminate the internal resources and costs typically required for data ingestion and formatting
• Benefit from 24-hour verification cycles to keep directories up to date

With Perspecta, health plans gain clean, compliant, fully auditable provider directories — every day, not just during audit season.

Learn more about Perspecta's Data Cleansing & Verification Services

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