Understanding the 2025 NCQA Credentialing Standards for Healthcare Providers
Atlas PRIME® is ranked Best Provider Data Management Platform of 2025 by MedTech Breakthrough → Read More
Atlas PRIME® is ranked Best Provider Data Management Platform of 2025 by MedTech Breakthrough → Read More
Optimize and secure provider data
Streamline provider-payer interactions
Verify real-time provider data
Verify provider data, ensure compliance
Create accurate, printable directories
Reduce patient wait times efficiently.
09 Jul, 2025, 12 min read
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Getting ahead of these standards means breaking your plan into manageable actions. Here is a practical checklist you can apply right away:
By moving now, you protect your program from gaps that could cost accreditation and disrupt your provider network.
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:
Each of these outcomes supports your team’s mission to protect patient safety, maintain fair access, and operate with confidence.
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:
These practices protect your accreditation, improve onboarding speed, and keep your provider network steady as NCQA standards evolve.
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:
What NCQA Requires:
Verification of credentials within 120 days (accreditation) or 90 days (certification), including Medicare and Medicaid exclusion checks.
Atlas Capability:
What NCQA Requires:
Monthly checks for Medicare/Medicaid exclusions and real-time tracking of license renewals.
Atlas Capability:
What NCQA Requires:
Voluntary collection of race, ethnicity, and language data with a non-discrimination disclaimer.
Atlas Capability:
What NCQA Requires:
Audit trails showing who changed provider data, what was changed, when, and why. Requires annual training on data integrity.
Atlas Capability:
What NCQA Requires:
A unified credentialing program structure with flexible scoring and interim surveys.
Atlas Capability:
What NCQA Requires:
A system capable of supporting real-time data updates, audit trails, monitoring, and credentialing workflows.
Atlas Capability:
What NCQA Requires:
Organizations must be fully compliant for surveys conducted on or after July 1, 2025.
Atlas Capability:
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.
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.
You must comply by July 1, 2025. Any surveys scheduled on or after that date will use the updated NCQA credentialing program requirements.
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.
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.
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.
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.
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.