How to Navigate the NCQA's 2025 Credentialing Updates

The National Committee for Quality Assurance (NCQA) unveiled significant changes to its credentialing standards for 2025. These annual updates are designed to help healthcare organizations adopt industry best practices and streamline the credentialing process for licensed healthcare professionals.

The NCQA 2025 updates are pivotal in shaping how the country’s healthcare organizations enhance credentialing efficiency, improve data accuracy, and maintain alignment with industry standards. It is critical for all stakeholders—healthcare systems, plans, providers, regulators, and IT/security teams—to stay informed of these changes to properly adjust their workflows, tools, and compliance strategies.

While NCQA accreditation is not universally required, it remains an important benchmark for quality care, patient safety, and operational performance. Healthcare organizations that achieve NCQA accreditation demonstrate a steadfast commitment to delivering high-quality care and meeting rigorous, evidence-based targets. Many states require NCQA accreditation for managed care plans such as Medicaid.

Why do NCQA 2025 changes matter?

The NCQA 2025 updates, which were finalized in August 2024, reflect the evolving priorities for healthcare credentialing and accreditation, addressing the growing complexities of the industry. As healthcare capabilities and dynamics advance through technology, these updates aim to streamline processes, elevate care quality, and strengthen compliance.

The NCQA 2025 changes encourage healthcare organizations to:

• Enhance provider quality and safety by adopting more robust verification and monitoring systems.
• Streamline credentialing and ensure regulatory compliance with efficient, automated processes that reduce administrative burden.
• Drive cost efficiency using automated tools and real-time data, optimizing resource allocation.
• Strengthen data integrity, security, and privacy, ensuring that sensitive information is managed in accordance with the latest standards.
• Retire outdated processes, freeing up resources to focus on more impactful quality improvement initiatives.
• Enhance analytics and decision-making with advanced reporting and insights to support data-driven improvements.
• Prepare for future healthcare challenges by leveraging effective data management to stay adaptable and proactive.

What are the changes to the NCQA 2025 credentialing standards?

The NCQA credentialing 2025 updates are part of the ongoing effort by NCQA to keep credentialing processes aligned with current best practices, regulatory requirements, and industry needs.

While the changes are extensive, notable key updates include:

• Updated Verification Timelines
  Shortened timeframes allow organizations to access more up-to-date data, which is critical for risk mitigation and patient protection. For example, credentialing accreditation and health plan accreditation has been reduced from 180 days to 120 days. At the same time, verification for credentialing certification is now required within 90 days instead of 120 days. This applies to licenses, board certifications, and work history.
  
  Previously, credentialing timelines were based on manual processes for verifying data from primary sources. However, advancements in technology, along with approved primary sources that aggregate data from multiple channels, have significantly reduced the time required to obtain this information. Since credentials are dynamic, this reduction in verification time enables organizations to work with the most current and accurate data, enhancing the overall efficiency and reliability of the credentialing process.
  
  
• Ongoing Monitoring
  NCQA’s 2025 updates introduce several new requirements for both accreditation and certification, with a particular focus on monitoring. A key change is the continuous tracking of practitioner license expiration dates. NCQA is placing greater emphasis on ongoing monitoring of healthcare providers, moving away from the traditional re-credentialing process that occurs every 2-3 years.
  
  Credentialing will now require continuous monitoring for provider compliance, licensure status, disciplinary actions, and other critical data. This shift ensures that organizations can stay informed of any changes to a provider’s qualifications as soon as they happen, rather than waiting until the next credentialing cycle. The goal is to maintain up-to-date, accurate information and reduce potential risks associated with outdated or incomplete provider data.
  
  
• Information Integrity Standards
  With healthcare data privacy becoming an increasingly critical concern, the NCQA 2025 updates impose stricter measures to ensure that credentialing data is handled securely and remains in full compliance with HIPAA and other relevant regulations. Healthcare organizations will also need updated tools designed to track, manage, and report credentialing data securely, further safeguarding sensitive information.

How healthcare organizations can prepare

The updated guidelines will take effect on July 1, 2025, which means organizations need to start preparing now to align with the new NCQA standards. Credentialing and re-credentialing providers is a resource-intensive process, requiring significant time, personnel, and technology. To meet these updated standards, organizations must reassess and adapt their resources accordingly.

The good news? HealthStream's license and exclusion monitoring solutions through CredentialStream and Workforce Validate provide the tools you need to meet the new requirements and maintain the highest standards of patient safety. Our solutions reduce administrative burden and proactively mitigate risk through automated continuous monitoring and expert support, using one secure, centralized platform. Click here to request a demo and learn how HealthStream can help your organization.

Implementing the NCQA changes will help organizations better navigate broader shifts in the healthcare system, such as the rise of digital healthcare, the increasing demand for diverse care models, and the ongoing emphasis on patient safety and quality improvement. By adopting the updates, healthcare organizations will be better positioned to deliver high-quality care, mitigate risks, and remain competitive in an ever-evolving, complex healthcare landscape.