Understanding the 2025 NCQA Credentialing Standards for Healthcare Providers

If you oversee credentialing, you know how much is riding on NCQA compliance. The National Committee for Quality Assurance has rolled out major updates to its credentialing standards on July 1, 2025. These updates will now reshape how you verify, monitor, and document provider qualifications. You must move faster, track data more closely, and address new requirements around practitioner demographic data.

The upside? These changes can help you reduce risk, strengthen your provider network, and support equitable access to care. 

In this blog, you will get a clear view of what these 2025 NCQA credentialing standards mean for your program and the practical steps to keep your accreditation secure.

What are the NCQA Credentialing Standards?

NCQA credentialing standards define how you confirm that a practitioner is qualified to deliver safe and effective care. They outline what details you must collect, how you must verify them, and which processes should guide those decisions.

If your team handles the entire process, from initial verification through committee review and ongoing monitoring, you look to NCQA’s credentialing accreditation standards. If you only verify credentials for other groups, you follow the credentialing certification track.

You probably already rely on these standards to build confidence in your provider roster, maintain payer relationships, and keep quality high. With this update, you will see clearer guidance on what data counts, how to document updates, and how to manage integrity across every credentialing cycle.

Why did NCQA Change its Credentialing Standards in 2025?

You already manage countless demands in credentialing, but NCQA recognized the industry needed modern guardrails. The 2025 updates aim to match today’s technology capabilities and protect patients with tighter, faster oversight.

In the past, credentialing teams relied on paper records and manual follow-ups that slowed decisions and increased risks. With digital systems now widely available, NCQA expects you to verify practitioner details more quickly and keep monitoring data up to date. That push helps ensure you catch issues before they affect patient safety.

NCQA also responded to calls for greater equity. By encouraging the collection of race, ethnicity, and language data, while making participation voluntary for practitioners, these rules support more inclusive care and improve visibility into the practitioner landscape.

When you follow these updated standards, you support not just compliance but better-quality credentialing overall.

Key Changes in 2025 NCQA Credentialing Standards

The 2025 updates introduce practical, enforceable requirements that you will need to build into your credentialing workflows. Let’s look closely at what has changed, so you can prepare your program confidently.

1.  Policy and procedure requirements

You now need to define in your credentialing policies how the committee will handle practitioner sanctions, complaints, and adverse events flagged during ongoing monitoring. NCQA also shortened the notification window for credentialing and recredentialing decisions to 30 calendar days. You will want to confirm that your internal review and communication processes can support that.

2. Practitioner applications

Practitioner applications must include fields to collect race, ethnicity, and languages spoken. These questions remain voluntary, but you must include a clear non-discrimination statement. NCQA expects you to share these demographic insights with your peer-review committees so they can see trends in your network. Build in staff education so these fields are handled respectfully and consistently.

3. Primary source verification

NCQA shortened the maximum primary source verification window from 180 to 120 days before the committee decision. If you follow the certification program, your window shrinks to 90 days. Alongside that, you must check for Medicare and Medicaid exclusions and document these results. Make sure your verification partners or delegated CVOs understand and follow this timeframe.

4. Ongoing monitoring requirements

Monthly monitoring now includes Medicare and Medicaid exclusions, SAM.gov checks, and any other relevant exclusion databases you rely on. You also need to track practitioner license expirations in real time, with evidence of renewal documented in every file. Since these checks feed into the credentialing committee or designated peer-review meetings, your monitoring reports must be clear and current.

5.  Information integrity standards

NCQA replaced “system controls” with “information integrity,” strengthening expectations around data change tracking. You must define which updates are acceptable during a credentialing cycle and document exactly what changed, who made the change, when, and why.
Your team will need annual training on this standard, plus an annual audit that specifically targets inappropriate updates. When the audit uncovers issues, you must document corrective actions and re-audit within three to six months to verify that those actions worked.

6.  Scoring and accreditation status

The scoring system for credentialing accreditation now uses “met,” “partially met,” or “not met,” replacing the numeric scale. Credentialing certification programs will shift to a three-year lookback and a three-year status instead of two. NCQA also created provisional statuses and an interim survey pathway to give more flexibility while maintaining oversight.

7.  Interactive Review Tool (IRT)

You will need to use NCQA’s consolidated Interactive Review Tool, which brings all credentialing program standards into one system. Plan enough time to train staff on using this tool so you can submit materials correctly and avoid delays.

8.  CMS Wait Time Compliance Alignment

NCQA is aligning credentialing with federal CMS wait time standards, which means you may need to integrate data from appointment access surveys, including secret shopper studies, into credentialing reviews. This helps confirm network adequacy and timely access for members.

9.  Audit Trails and Documentation

Beyond standard file review, NCQA expects you to keep a full audit trail for every credentialing data change. That trail should capture who made the change, why, when, and what exactly changed. If you rely on a delegated partner or a vendor, confirm they can provide these audit details on demand.

Many credentialing leaders have already summarized these changes in the field. John K. Lamb, Vice President of Provider Operations at Atlas Systems, noted that teams should pay close attention to the shortened notification window and the emphasis on documenting exclusions. These details often get overlooked in day-to-day processes, but now carry significant compliance weight.

How to Prepare for NCQA 2025 Credentialing Changes

Getting ahead of these standards means breaking your plan into manageable actions. Here is a practical checklist you can apply right away:

• Review and update policies
  Examine how your team documents committee reviews, sanctions, complaints, and adverse events. Adjust your notification process to meet the new 30-day decision window.
• Modernize your practitioner application
  Add fields for race, ethnicity, and languages spoken, and include a non-discrimination statement. Train staff so they feel comfortable explaining these questions to practitioners.
• Assess your technology
  Test whether your systems can support 120-day or 90-day verification deadlines, run monthly exclusion checks, and track license expiration dates. Confirm your platform logs updates with who, what, when, and why.
• Strengthen staff training
  Plan annual refreshers on information integrity, appropriate documentation, and spotting errors. NCQA will expect proof that you consistently train everyone on these requirements.
• Revisit delegation agreements
  If you use a CVO or another partner, check their capabilities against the new timelines and monitoring rules. Validate their reporting before you finalize compliance plans.
• Set a project timeline
  Map milestones for policy updates, training sessions, system upgrades, and test reviews. Spread the work across the coming months so you do not scramble as the deadline approaches.

By moving now, you protect your program from gaps that could cost accreditation and disrupt your provider network.

Benefits of Complying with the 2025 Standards

Meeting the 2025 NCQA credentialing standards does more than avoid citations; it supports a stronger, safer network. Here is what you gain by aligning your processes:

• Lower risk exposure
  Tighter verification timelines and frequent monitoring help you identify problems before they put patients or your organization at risk.
• Better provider data quality
  Monthly exclusion checks, license tracking, and clearer data integrity procedures build confidence in your network directory.
• Faster onboarding
  With well-documented processes and up-to-date credentialing systems, you can move providers through onboarding more quickly, supporting clinical coverage needs.
• Improved equity and transparency
  Voluntary race, ethnicity, and language questions give you insights into your network’s diversity and strengthen cultural competence.
• Stronger compliance posture
  Proving that you meet NCQA’s updated documentation, audit, and data integrity requirements positions your program for long-term accreditation and trust from payers.

Each of these outcomes supports your team’s mission to protect patient safety, maintain fair access, and operate with confidence.

Best Practices to Stay Ahead

Adjusting to NCQA’s 2025 credentialing updates goes beyond rewriting a policy; you need a proactive approach that supports compliance year-round. Consider these steps to keep your program strong:

• Automate verification with trusted technology
  Solutions from Atlas Systems, including automation for primary source verification, monthly exclusion monitoring, and license tracking, can help you meet the NCQA credentialing standards 2025 more reliably than manual workflows. These tools protect against credentialing delays and build confidence in your compliance reporting.
• Build custom reports
  Develop reporting dashboards that highlight practitioner demographic data, audit findings, and credentialing committee decisions. Connecting these reports directly to your peer-review process supports a more transparent NCQA credentialing program.
• Schedule routine training
  Block time each year for refresher courses on information integrity and data-change documentation. Share practical scenarios so your staff can apply the rules, not just memorize them.
• Test delegation partners
  If you rely on a CVO or other delegated credentialing partner, sample their files and verify they meet the updated NCQA credentialing requirements 2025. Keep those test results documented in case surveyors request evidence.
• Plan recurring audits
  Schedule internal reviews of credentialing files before NCQA surveyors arrive. Include checks on license renewals, exclusion data, demographic question handling, and the full audit trail.
• Follow NCQA communications
  Subscribe to NCQA’s bulletins, attend webinars, and review any clarifications they post. Staying current reduces last-minute surprises and positions you for long-term success.

These practices protect your accreditation, improve onboarding speed, and keep your provider network steady as NCQA standards evolve.

How Atlas Systems Supports Your Credentialing Success

Meeting the NCQA 2025 credentialing standards requires healthcare organizations to modernize their processes, from credential verification to demographic data capture and ongoing monitoring. Atlas Systems empowers your credentialing operations with AI-driven platforms, real-time data exchange, and robust compliance support.

Here’s a breakdown of how Atlas Systems directly supports each new NCQA requirement:

1. Primary Source Verification (PSV) within 90–120 Days

What NCQA Requires:
Verification of credentials within 120 days (accreditation) or 90 days (certification), including Medicare and Medicaid exclusion checks.

Atlas Capability:

• Atlas PRIME® uses direct primary source outreach, not data aggregation, to validate credentials.
• Built-in tracking ensures real-time PSV completion and up to 95% data accuracy, accelerating onboarding and reducing the risk of claim denials.

2. Monthly monitoring of exclusions and licenses

What NCQA Requires:
Monthly checks for Medicare/Medicaid exclusions and real-time tracking of license renewals.

Atlas Capability:

• PRIME® includes real-time sanction, exclusion, and license monitoring using authoritative sources such as the Death Master File and state boards.
• Automates alerts and documentation to ensure nothing falls through the cracks.

3. Updated practitioner applications with demographics

What NCQA Requires:
Voluntary collection of race, ethnicity, and language data with a non-discrimination disclaimer.

Atlas Capability:

• Credentialing forms and workflows are fully customizable to include NCQA-compliant demographic fields.
• Built-in disclaimers and training tools help staff communicate that responses are voluntary and non-discriminatory.

4. Enhanced information integrity and change documentation

What NCQA Requires:
Audit trails showing who changed provider data, what was changed, when, and why. Requires annual training on data integrity.

Atlas Capability:

• Every provider data change is tracked in the PRIME dashboard with full transparency.
• The Ask PRIME AI engine provides instant reporting, and annual compliance training modules support staff in retaining knowledge.

5. Merged credentialing, accreditation, and certification model

What NCQA Requires:
A unified credentialing program structure with flexible scoring and interim surveys.

Atlas Capability:

• Atlas PRIME unifies credentialing and directory workflows across accreditation and certification tracks.
• Supports integrated scoring, centralized dashboards, and policy alignment for interim or full NCQA evaluations.

6. Credentialing technology that enables readiness

What NCQA Requires:
A system capable of supporting real-time data updates, audit trails, monitoring, and credentialing workflows.

Atlas Capability:

• PRIME PPC® automates every part of the credentialing lifecycle — PSV, exclusion tracking, license monitoring, and reporting.
• Seamlessly integrates with EMRs, billing systems, and delegated credentialing partners while ensuring CMS and NCQA alignment.

7. Structured readiness planning ahead of July 2025

What NCQA Requires:
Organizations must be fully compliant for surveys conducted on or after July 1, 2025.

Atlas Capability:

• Atlas provides a custom implementation roadmap with testing milestones, policy updates, mock audits, and credentialing system optimization.
• Go live in under 30 days, with full support through survey preparation and beyond.

If you want to explore the full 2025 NCQA credentialing standards, you can review the official NCQA publication for the most current details.

And, If you would like to explore how Atlas Systems can make your credentialing program stronger and more resilient, connect with our team today. 

FAQs

1. What are the new NCQA credentialing requirements in 2025?

The 2025 NCQA credentialing standards include shorter primary source verification timeframes (120 days for accreditation, 90 days for certification), stricter monthly exclusion checks, license expiration tracking, and new rules on documenting updates under the information integrity standard. NCQA also expects credentialing applications to collect voluntary race, ethnicity, and language data with a clear non-discrimination statement.

2. What is the deadline to meet the 2025 NCQA credentialing standards?

You must comply by July 1, 2025. Any surveys scheduled on or after that date will use the updated NCQA credentialing program requirements.

3. How long do I have to verify practitioner credentials under the new standards?

For NCQA credentialing accreditation, you have up to 120 days before the committee’s decision. If your organization uses NCQA credentialing certification, you must complete verification within 90 days. These tighter windows help maintain current, reliable provider data.

4. Is it mandatory for providers to answer race and language questions on the application?

No. These questions must be included, but practitioner responses stay voluntary. NCQA requires you to state clearly that answers will not be used to discriminate against a practitioner.

5. What is the NCQA single credentialing program?

You risk losing your NCQA accreditation or certification, which can jeopardize payer contracts and damage your provider network. Gaps in credentialing can also expose your organization to compliance penalties and patient safety risks.

6. Can credentialing software help meet the NCQA credentialing standards 2025?

Yes. Automated credentialing platforms, like those supported by Atlas Systems, can handle primary source verification, license monitoring, exclusion checks, and audit trails. These features align with NCQA’s updated standards and help your team stay compliant.

7. What happens if my program does not meet the NCQA 2025 requirements?

You risk losing your NCQA accreditation or certification, which can jeopardize payer contracts and damage your provider network. Gaps in credentialing can also expose your organization to compliance penalties and patient safety risks.