Don’t Wait for the REAL Health Providers Act

If you manage provider data, you already know the industry is changing quickly, and the days of relying on outdated directories and manual updates are over. Laws like the No Surprises Act have already reshaped how provider information is managed, and the upcoming REAL Health Providers Act, set to take effect in 2026, will accelerate that shift. This is no longer just about compliance; your organization’s ability to deliver accurate, accessible information is essential for transparency, trust, and better care outcomes.

While the REAL Health Providers Act hasn’t taken effect and still awaits full implementation, it builds directly on the foundation laid by the No Surprises Act, signaling a continued push for greater transparency and accountability in provider data management. So, what do these changes actually mean for you and your data management strategy? Let’s break down what’s required, why it matters, and smart steps you can take—today—to meet the new standards and avoid costly pitfalls.

How the REAL Health Providers Act Impacts Provider Data Management

As the healthcare industry braces for the 2026 implementation of the Required Enhanced and Accurate Lists of Health Providers, known as the REAL Health Providers Act, it’s evident: accurate provider data management no longer just supports care delivery – it defines it.

The Act aims to tackle a long-standing issue in healthcare: unreliable provider directories. For years, patients have faced the consequences – looking for in-network providers, only to discover that the names listed in directories are outdated, no longer accepting patients, or simply out-of-network. The result? Patients suffer from postponed care, unexpected bills, and a critical trust deficit.

Let’s understand this legislation, requirements, impact, and how organizations can proactively prepare with smarter provider data management systems setting the standard.

What is the REAL Health Providers Act?

If enacted, the REAL Health Providers Act will mandate standards for Medicare Advantage organizations to keep their provider directories up-to-date and publicly accessible.

Health plans will be expected to:

• Maintain a public-facing provider directory including essential information: Provider name, specialty, contact details, location, accessibility features, etc.
• Verify provider directory data at a minimum of every 90 days, updating information accordingly
• Remove providers from directory within five business days of determining out-of-network status
• Conduct an annual directory accuracy analysis – including error-prone categories such as mental health and substance use providers

This is more than a compliance checklist – it’s a full transformation of how health plans manage, update, and share provider data.

Ghost Networks are Real – and the REAL Act Aims to Fix Them

If you’ve ever tried to schedule a healthcare appointment and found yourself calling provider after provider, only to learn none of them were available or even in-network, you’ve experienced a ghost network firsthand. This occurrence takes place when health plan directories list providers who are not available, creating a misleading picture of network adequacy and access to care.

Ghost networks disproportionately impact seniors, individuals with disabilities, and anyone seeking behavioral health services – populations the REAL Health Providers Act was specifically written to protect. It’s designed to help patients avoid dead ends, reduce misrouted referrals for providers, and pushes payers to improve provider data management.

Why This Issue Isn’t Just About Compliance

Compliance isn’t just about responding to the rules. It’s about building the infrastructure to proactively support accuracy, transparency, and trust – every day, at scale. For many organizations, this means moving away from legacy systems, manual updates, and siloed workflows. Let’s be honest, the industry has been slow to modernize how we handle provider data. In too many organizations, the data lives in separate ecosystems.

But this is about more than quarterly verification and five-day removal windows. It’s a push to fundamentally shift how provider data management is approached. The REAL Health Providers Act redefines what “accurate” really means – data must be real-time, complete, and immediately reflected across every member-facing channel. That’s a tall order if you’re managing disconnected systems or relying on outdated processes.

How Gaine Coperor Helps You Meet the Moment

Staying ahead of provider data requirements means moving away from siloed systems and manual fixes—which is easier said than done. That’s where Gaine Coperor comes in. Coperor gives you a single source of truth for provider data, integrating information from credentialing, core admin, EMRs, and reference feeds like NPPES and state boards, all in real time. With automated cleansing, matching, and survivorship rules, you no longer have to worry about duplicates or conflicting records when it’s time for an audit or a directory update. The platform includes easy-to-use console for data stewardship and reporting, making it simple to resolve exceptions and track progress against quality goals.

Most importantly, Coperor is built for healthcare and scales with you—so you’re prepared not just for today’s regulations but for what’s next. You’ll cut down on manual work and administrative spend, reduce compliance risk, and deliver a stronger provider experience. Your teams can collaborate, share trusted data with partners, and quickly respond to new business needs without missing a beat. With Coperor, you can focus on proactive improvements, deeper analytics, and truly reliable provider data at every touchpoint, all while knowing you’re ahead of compliance and ready for the future.

Looking Forward: Data Accuracy Is the New Standard

Here’s the bigger picture: the REAL Health Providers Act is not just a regulatory hurdle – it’s a catalyst for transformation. Because when provider information is accurate, accessible, and up to date, everyone benefits. Patients get better access to care. Providers are easier to find, schedule with, and refer to. Health plans reduce administrative burden and avoid costly mistakes. And the system, finally, becomes a little easier to navigate. Even if new regulations stall or change, there’s little downside—and plenty to gain—from investing in cleaner, more reliable provider data now. Why wait? Start building for accuracy today, and you’ll be ready for whatever comes next.

Ready to take the next step toward cleaner, smarter provider data?
Contact us today to speak with a Gaine health data management expert and see how you can get ahead—no matter what comes next.