Free checklist for payer data, IT, and member experience leaders

Is your member data ready for AI?

58% of insured adults had a problem with their health insurance in the past 12 months, according to KFF. Not every one traces back to identity data, but a meaningful share do: a member who looks like three people to three systems.

This checklist shows where those gaps will surface first, in a Star Ratings score, a payment integrity audit, or an AI model, so you can close them before they do.

Inside: 20 checks across five sections
01Member identity foundation
02Provider directory accuracy
03Quality, Stars, and risk adjustment
04Payment integrity and fraud
05AI and analytics governance
Free download

Get the checklist

Instant access to the 3-page PDF.

Your checklist is ready

A copy is on its way to your inbox. Work through it with your data, IT, and member experience leads. Anything left unchecked is your starting point.

Open the checklist (PDF)
Next step

See where your identity data stands with a free assessment from our team.

Get the free assessment
Do the math: the 90-day clock

What does it cost to keep your directory honest?

The No Surprises Act requires provider directory verification at least every 90 days. Enter your directory size to see what a manual process costs in staff time, four times a year.

providers
1,000150,000
How your team verifies today
Every year, just to stay current
7,033staff hours
That is about 3.4 full-time people doing nothing but verification.
1,758 hours every 90 days. Then the clock resets.
See the other 19 checks

Time per provider from AHIP and Availity: about 4.22 minutes by phone to over 16 minutes online. "Half and half" averages the two. Assumes four verification cycles a year and 2,080 working hours per full-time employee. Your numbers will vary.

Try it now: five quick questions

How ready is your foundation?

Mark each section in place or not yet. The full checklist goes four checks deep on every one.

12345
0
of 5 sections in place
Where do you stand?
Answer all five to see where your foundation stands.
Get the checklist
1
Member identity foundation
One owner is accountable for member identity across claims, enrollment, and engagement.
In placeNot yet
2
Provider directory accuracy
Your directory is validated against an outside source at least every 90 days.
In placeNot yet
3
Quality, Stars, and risk adjustment
Outreach, quality activity, and chart reviews all trace back to one member record.
In placeNot yet
4
Payment integrity and fraud
Suspicious patterns surface across members, providers, and claims, not just one system.
In placeNot yet
5
AI and analytics governance
Duplicate member records are caught before they reach a model, not after.
In placeNot yet
0 of 5 in place
Where do you stand?
Get the checklist
58%
of insured adults had a problem with their health insurance in the past 12 months
Source: KFF
50%
of providers had at least one directory deficiency in a CMS review
Source: CMS Provider Directory Review, Round 3
2.1x
more net members added by 4+ Star Medicare Advantage plans than lower-rated competitors
Source: McKinsey

Verato helps us manage these scenarios so we can compile that true longitudinal view, leverage the data accurately, and have accurate calculations at the end of the day.

Senior director of HEDIS, a large health plan
Verato®, the identity intelligence experts, powers exceptional experiences everywhere by solving the problem that drives everything else – knowing who is who.™
© 2026 Verato. All rights reserved
Privacy | Terms | verato.com