Payer Enabled Directory guides orders and referrals

How Payer Enabled Directory makes network strategy actionable

A referral can seem like a small moment in the care journey — a patient needs a specialist, a provider orders imaging, or a care team sends lab work to a familiar facility. But for health plans, that moment carries real weight.

A single referral can determine whether a member stays in network, whether care is directed to a preferred site, whether costs are predictable, and whether the experience feels simple or frustrating. Yet it’s also a moment where payer strategy has limited influence — not because providers ignore it, but because the right information often isn’t available at the point of decision.

In practice, referral decisions are made quickly, often relying on familiar providers, proximity, or long-standing habits. But those choices are not always the best match for a member’s plan. Without health plan data in the workflow, providers may not know which options are in network, which facilities are preferred, or which carry payer-specific quality or efficiency designations. The result can be misaligned referrals that create friction before care even begins.

That gap has real implications. U.S. healthcare spending grew 7.2% in 2024 to $5.3 trillion — 18% of GDP.¹ For payers focused on affordability, network performance, and member experience, it’s no longer enough to design strong networks. Network intelligence must be visible where care decisions are made.

How Payer Enabled Directory can support better referral decisions

Payer Enabled Directory brings health plan network intelligence into athenaOne® ordering workflows so providers can see relevant options as they make referral decisions.

When ordering a specialty referral, imaging service, or lab, providers are shown best-match options aligned with the patient’s primary insurance. This includes in-network providers, preferred facilities, and payer-specific cost, quality, and efficiency designations. This helps providers make informed decisions without leaving their workflow or relying on external tools.

Payer Enabled Directory is not about forcing a referral path or asking providers to adopt a different process for every payer. It’s about making payer information easier to use inside a consistent, payer-agnostic experience. The provider stays in the workflow. The member gets a referral that is more likely to align with their coverage. The payer has a better chance of seeing its network strategy reflected in real care patterns.

Here are three of the most common points where ordering can create friction, and how Payer Enabled Directory can help.

Pain Point 1: When members are sent to providers who do not match their coverage

The pain of mismatched coverage is personal for members. Not only are they dealing with their health issues, but they may also have to figure out what went wrong and what to do next.

For payers, the same moment becomes operational work. Service teams may need to help the member find another provider. The original practice may need to be contacted, and a new referral or order requested. And the plan will likely absorb the dissatisfaction caused by a bad handoff, even if the payer had the right network information available somewhere else.

To address this challenge, Payer Enabled Directory identifies referral options that accept the patient’s primary insurance and surfaces network designations directly in the ordering workflow. That means the provider doesn’t have to leave the system, search a payer portal, or rely on memory to identify a better-aligned option. As a result, network alignment happens before the referral is sent, not after the member encounters an issue with coverage.

Pain Point 2: Preferred providers and facilities aren’t suggested at the point of care

Health plans invest heavily in network design. They identify in-network, preferred providers, facilities, and sites of care. They maintain data about cost, quality, and efficiency. But none of that matters much if the information doesn’t reach the ordering provider.

For example, a provider orders an MRI and sends the member to a facility the practice usually uses. It may be nearby and familiar, but it may also be a higher-cost site than another in-network option that the payer would have preferred for that service.

This can mean higher costs and a less predictable member experience. For the payer, it means the plan’s site-of-care strategy missed the moment when it could have shaped the referral.

Payer Enabled Directory surfaces payer-recommended options, including in-network providers and facilities with cost and efficiency designations, in the ordering process. Instead of payer strategy living in a separate system, it appears where and when the referral is being made. That’s how network design becomes actionable guidance at the point of referral.

Pain Point 3: Provider friction grows when payer guidance is missing

Even when payer guidance is available, it often lives outside the provider’s workflow, such as in payer portals or separate tools.

AMA data released in 2026 found that 41.9% of physicians reported at least one symptom of burnout in 2025.² So, if referral guidance requires a provider or staff member to stop, open a different tool, search a portal, compare plan rules, and then return to the order, it’s easy to understand why that step may not happen consistently. Adding more manual work to the referral process is not a scalable answer, meaning even high-quality network data may not change behavior because the path to use it is too hard.

To help reduce provider effort in making network-aware referrals, Payer Enabled Directory embeds payer intelligence into native athenaOne workflows. Providers see relevant, best-match options aligned to the patient’s primary insurance without taking extra steps or switching systems. By removing friction, it becomes easier for providers to incorporate payer guidance into everyday decisions.

It’s not just the data. It’s also about reach.

Even the best network strategy has limited impact if it can’t scale, especially for high-volume services like labs and imaging, where referral decisions happen constantly throughout the day. One-off outreach, static directories, or workflows that vary by plan make it difficult and expensive for payers to consistently influence where those orders are sent. That’s what makes Payer Enabled Directory’s connection to athenaOne so valuable.

Payer Enabled Directory is part of the broader athenaPayer portfolio, which simplifies payer-provider interoperability through athenaOne. As a cloud-based, single-instance platform, athenaOne helps payers connect with more than 170K clinicians across a range of specialties.³ This built-in reach enables payer guidance to surface directly within ordering workflows for services like imaging and lab work, where site-of-care and network alignment matter most.

In summary

When payer information shows up too late, or isn’t seen at all, the opportunity to guide the referral may already have passed. By surfacing in-network, high-quality order and referral options directly in athenaOne ordering workflows, Payer Enabled Directory helps payers make their network strategy actionable in the moment it’s needed most.

Learn more about how Payer Enabled Directory helps simplify referral decisions by surfacing in-network, high-quality providers within the ordering workflow.