How To Get Ahead of the 2025 NCQA Credentialing Changes

The National Committee for Quality Assurance (NCQA) is forcing the hands of healthcare organizations who have been reluctant to adopt credentialing technology. The NCQA 2025 credentialing standards shorten verification timelines, increase monitoring requirements, and add data for collection — all of which are significantly easier for organizations using credentialing software.

NCQA notes that previous guidelines were set when credentialers relied on manual processes. With the advances in technology that enable more efficient processes, credentialing should be completed faster and more accurately to improve the quality of healthcare.

These are some of the benefits that NCQA hopes healthcare organizations will experience:

• Mitigate Risk: Organizations working with more recent data will reduce risk and offer visibility into activities like potential changes to data, monitoring gaps, and more.
• Improve Equity: The collection of provider race, ethnicity, and languages spoken is known to improve equity, helping to better meet the needs of a diverse patient population. 
• Reduce Adverse Events: Additional exclusions monitoring requirements promote faster action to prevent unintended patient incidents or quality issues. 

In this article, I’ll outline the 2025 NCQA changes (effective July 1, 2025) and share best practices to adjust credentialing processes to easily meet the new credentialing standards.

What Is NCQA Accreditation?

Meeting NCQA standards is viewed as the gold-standard for credentialing. In fact, many states set their own expectations based on NCQA standards and leading credentialing software vendors incorporate the standards into their products. The NCQA has two credentialing-related programs: credentialing accreditation and credentialing certification.

NCQA Credentialing Certification

NCQA Credentialing Certification is for organizations that provide specific credentialing services, such as a credential verification organization (CVO). The certification program focuses on verification operations with standards for each of the 11 types of verifications required.

NCQA Credentialing Accreditation

NCQA Credentialing Accreditation is designed for organizations that provide full-scope credentialing services. Most healthcare organizations handling their own credentialing process fall into this category. In addition to the strict verification requirements required for certification, accreditation also meeting standards related to a credentialing committee, ongoing monitoring, recredentialing cycle length, and assessment of organizational providers.

Snapshot of the Credentialing-Related 2025 NCQA Changes 

Changes to the NCQA 2025 credentialing standards were informed by industry experts and public feedback. The information below is a brief listing of the 2025 changes to NCQA credentialing standards. For a more comprehensive look, please refer to NCQA directly. 

Changes To NCQA Credentialing Standards

1. Shortening the verification timeframe.

The verification timeframe from 180 days to 120 days for credentialing accreditation and health plan accreditation and to 90 days for credentialing certification. This includes all credential types: license to practice, board certification, work history, malpractice history, state licensing sanctions, and both Medicare/Medicaid sanctions and exclusions. 

2. Changes to credentialing application.

The application attestation timeframe has been shortened considerably. There are also two new requirements related to provider race, ethnicity, and language. The first is required fields for this information on the credentialing application (that is voluntary for providers to complete) and the second is inclusion of a required non-discriminatory statement. These changes apply to both accreditation and certification.

3. New ongoing monitoring requirements.

There are several new requirements for both accreditation and certification that are related to exclusions monitoring, in addition to the new requirement that practitioner license expiration dates are tracked continuously. This doesn’t call for monthly monitoring of all credential information — only monthly monitoring of the license expiration date. The new exclusion check requirements include:

• Checking all exclusions at least monthly (within 30 calendar days)
• Requirement to check Medicare/Medicaid exclusions 
• Requirement to check SAM.gov

Findings from the ongoing monitoring must be shared, and the 2025 NCQA updates expand beyond the credentialing committee to include another designated peer-review body.

4. Changing system control requirements to the information integrity standard.

There are extensive changes to this section of requirements, which will need much further review than this article. In short, many of the requirements were clarified and scopes were more clearly defined, and a training requirement was added.

Changes To Credentialing Program Design

All standards are now in a single publication and there’s a single interactive review tool (IRT). When you purchase the 2025 NCQA standards, you’ll have access to all programs and IRTs.

1. Additional statuses for credentialing programs.

There is now an interim survey option for credentialing accreditation and the two-year status was replaced with a provisional status. The credentialing certification program has a new name and has moved from a two-year to three-year status with a three-year look-back period.

2. Redefining credentialing scoring to align with health plan accreditation.

Credentialing accreditation will now be given the following scores: met (formerly 100%), partially met (formerly 50%), and not met (formerly 20% or less).

How To Adjust Credentialing Processes To Meet 2025 NCQA Updates

NCQA has been very clear that their credentialing standards are aligning with the capabilities provided by technology. In short, the best way to adjust your processes to meet the 2025 NCQA updates is to implement credentialing software. But, to meet the updated standards, you’ll need to go beyond just credentialing automation. You likely need a comprehensive credentialing platform that provides advanced workflows, data management, and reporting. Below are the features I recommend you look for in a solution.

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Automated License Verification

With NCQA shrinking license verification timelines, automation just makes sense. Let technology automatically find provider licenses, pull copies into the platform, and scrape the basic data you need from the license. Then, a credentialer can verify the correct license(s) for the provider and be sure the license is active. Choose a technology solution that tracks this verification with the verifier’s name, the date, and trusted URL.

This automation is also available for DEA registrant validation, but with the 2024 DEA verification changes, make sure you select a vendor that has registrant dataset access (RDA) to ensure you’re compliant with regulatory and accreditation agencies. 

Ongoing Monitoring

NCQA’s ongoing monitoring requirements related to exclusions are also solved with automation. Manually checking state, SAM, and OIG exclusion databases for every provider, every month is incredibly time consuming. Choose credentialing software that offers automated exclusions monitoring — be sure to choose a vendor that notifies you when a provider’s exclusion status changes and tracks the date of the last check for every provider.

Customizable Reports

The real-time status updates provided by software reporting can’t be undervalued, especially when you now have to monitor license expiration dates. Choose software that tracks the dates and offers the ability to save and schedule reports to email automatically — since you’re also required to share your findings with the credentialing committee to include another designated peer-review body.

Customizable reports are also handy when you want to analyze the new provider data you’re collecting as part of the 2025 credentialing standard updates. Adding in custom fields that you can pull into reports with any other credentialing data will make it simple to both meet the requirement and also improve equity in your organization.

Choose the Best Credentialing Software

For many healthcare organizations, it’s time for a credentialing process upgrade. NCQA originally wanted to shorten the verification timeline even more (to 90 days for accreditation), but acquiesced to pushback, so you’ll likely see that number again in the future.

Instead of adding one or two tools to get by, take this opportunity to invest in best-in-class credentialing software, such as MedTrainer Credentialing. Built to grow with your organization and a rapid pace of innovation offer confidence you’re well positioned for all future NCQA changes. MedTrainer’s automated exclusions monitoring and license verification meet NCQA standards and customizable reporting makes it easy to stay audit ready.

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