NCQA 2025 Standards Are Here: What Credentialing Teams Need To Know

Healthcare organizations are facing a clear directive: modernize credentialing or risk falling behind. The NCQA’s 2025 credentialing standards reflect a shift that’s been building for years. These updates — effective July 1, 2025 — are NCQA’s push to keep pace with evolving technology and the operational realities of today’s healthcare landscape. 

Shorter Primary Source Verification (PSV) timelines, increased emphasis on audit readiness, and clearer team accountability are just the beginning. Interested in learning more about the 2025 NCQA credentialing changes? I lay all of the details out here! 

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As someone who has a lot of experience working in credentialing leadership across healthcare settings (and has loved it by the way), I understand the operational pressure these updates introduce — but I also see the opportunity. Below, I’ve outlined some of the most important questions I’ve heard from credentialing and compliance leaders regarding the 2025 NCQA updates, along with practical guidance for what to do next.

1. How are credentialing teams expected to handle verification more quickly without sacrificing accuracy or compliance?

The short answer? Use credentialing software that creates smarter workflows and more automation. Robust credentialing management software will create visibility, helping you identify gaps, make changes where necessary, and give your team the confidence they need to work efficiently and effectively.

Automate and Digitize: Manual verifications and email follow-ups won’t cut it under the new standards. Automating license verifications, exclusions, and PSV wherever possible is key. These automations not only save time — they reduce the risk of human error and ensure key data is captured in real time.

Standardize Processes & Ensure Accuracy: Accuracy starts at data entry. Prioritizing accuracy upfront will help you avoid costly errors and correctly track critical information such as license expiration dates (also a new requirement). Create a standard workflow with clear documentation and visibility. When everyone follows the same structured process — and the system supports that process — you reduce the chance of missing a step without compromising data.

Invest in Team Competency & Communication: Even with the best platform, your people need to know what’s expected — and why it matters. Ongoing training helps teams understand what’s expected, how to use tools correctly, and how to escalate concerns when necessary. Make sure your team understands the downstream impact of delays or errors. Understanding the compliance and patient safety risks tied to credentialing mistakes builds accountability and performance.

2. How can credentialing departments use these changes to improve internal workflows or secure more buy-in from leadership?

The NCQA credentialing standards offer more than just compliance requirements — they offer leverage. Here’s how credentialing teams can use the updates to elevate their work demonstrate value to leadership:

Simplified Processes & Scoring: The revised NCQA scoring framework helps organizations identify priority areas and take a more targeted approach to improvement. Interim surveys are a great way to test readiness, uncover gaps, and fix issues before the full survey process begins. Addressing areas for improvement before the survey mitigates risk and boosts compliance – something every leadership team wants to hear. 

Build a Stronger Case for Better Tools: Leadership teams respond to risk — and cost. Use data from your NCQA readiness assessment to highlight where inefficiencies are holding you back, then connect those issues to tool-specific solutions. For example, if you’re falling short on continuous monitoring, advocate for a platform with built-in monthly healthcare exclusion checks across all databases.

Use this worksheet to demonstrate the potential cost savings with better credentialing tools.

Showcase Efficiency, Safety, & Accreditation Readiness: The 2025 NCQA updates tie credentialing directly to patient safety and audit readiness. When you align, you’re not just compliant — you’re actively supporting the achievement and maintenance of accreditation. Once accreditation is earned, it should be protected with the same rigor. Proving your credentialing team is aligned with these standards shows leadership you’re safeguarding both safety and strategy.

3. What should we look for in a digital platform to ensure it aligns with the updated NCQA requirements?

Credentialing management software must do more than store documents — it should actively support compliance, collaboration, and visibility. Look for the following capabilities and more:

Automated Verification & Continuous Monitoring: Your platform should automatically track license expirations, run recurring OIG, SAM, and state exclusions checks, and log verification steps for audit readiness. The system should pull from primary sources, removing the need to jump between websites or offline records. Having a system that connects directly to data verification sources saves time and ensures accuracy. 

Streamlined Workflow & Secure Record Keeping: Credentialing software should act like a personal assistant, reminding you of deadlines, automating credentialing tracking and reporting, and helping move profiles through the credentialing funnel – all while keeping your files organized and secure. Built-in document tracking, expiration alerts, and role-based approvals are essential. 

NCQA Alignment & Custom Reporting: Your system should support NCQA’s data collection requirements, including optional demographic fields. Just as importantly, it should allow you to generate organization-specific reports that demonstrate compliance performance, PSV turnaround time, and outstanding verifications — all in real time. 

Staying Ahead with MedTrainer

These questions are only scratching the surface. Hear more of the discussion and biggest questions regarding the updates.

The NCQA 2025 credentialing standards create both urgency and opportunity. For credentialing teams, this is a chance to move beyond check-the-box compliance and become a strategic driver of safety, efficiency, and accreditation readiness.

At MedTrainer, we’ve designed our credentialing platform and services to meet these challenges head-on. From automated verifications and real-time tracking to centralized provider management and audit-ready reporting, every feature is built to align with NCQA expectations and beyond, all while reducing burden on your team.

See how MedTrainer gives your team the tools and support they need to handle credentialing – and any changes that come with it – confidently and efficiently. Learn more.