Online Provider Directory & Member Portal
This service will help you complete CMS regulation requirements through a certified provider credentialing specialist.
qualified
Regulatory-Ready. Commercial-Grade. Member-Focused.
ProviderLenz delivers a consumer-grade online provider directory and member portal built on a continuously curated, AI-enabled provider data foundation. The directory is designed to exceed CMS requirements for Medicare Advantage and Medicaid while also fully supporting the operational, contractual, and member experience needs of commercial health plans—including both federally qualified and non-federally qualified offerings.
By sourcing data directly from ProviderLenz’s validated provider system of record—not static extracts—the directory reflects near-real-time provider status, locations, affiliations, and network participation across all lines of business.
accessible
Designed for All Lines of Business
ProviderLenz supports consistent, accurate directory experiences across:
Medicare Advantage Plans
Meets and exceeds CMS directory accuracy and accessibility standards
Managed Medicaid Plans
Supports state access requirements and reporting obligations
Commercial Health Plans
Delivers accurate network visibility, contractual alignment, and improved member experience across employer, individual, and exchange products
Health Exchange Plans
Enhances consumer transparency and ACA compliance
A single platform supports multi-LOB directory management, eliminating fragmentation and inconsistency across plan types.
AI accuracy
AI-Enabled Accuracy from Source to Screen
The ProviderLenz Online Directory is powered by the platform’s multi-stage data curation and enrichment workflow, applying AI-assisted validation and automation to:
- Detect and resolve data discrepancies before they reach members
- Ensure network participation and provider attributes align with contracts and claims systems
- Automatically propagate validated changes across member-facing and operational systems
This results in a directory that remains accurate by design, not dependent on periodic manual refresh cycles.
Integration
Native Integration with Core Claims Platforms
ProviderLenz integrates directly with Facets and QNXT, ensuring alignment between member-facing directory data and the data used for:
- Claims adjudication
- Network and contract management
- Regulatory and internal reporting
For commercial and government plans alike, this integration reduces IT complexity, eliminates redundant data flows, and improves operational confidence.
Solution
Governance, Compliance, and Audit Readines
Health plans gain a defensible, scalable directory solution that supports compliance, reduces administrative risk, and improves member trust—across government and commercial markets.
ProviderLenz delivers enterprise-grade governance across all plan types:
Full data lineage and audit trails for provider directory attributes
Transparent update timing to support audits, complaints, and regulatory inquiries
Configurable validation rules aligned to regulatory, contractual, and internal standards