The NCQA 2025 updates are set to reshape credentialing standards, pushing payers and providers to rethink their processes. These updates introduce stricter timelines, enhanced data requirements, and new expectations for ongoing monitoring—raising the bar for compliance and operational efficiency
With these changes taking effect on July 1, 2025, the question isn’t “are you aware?”, it’s “are you ready?” Here are some of the key changes to consider as you begin to prepare for what’s ahead.
2025 NCQA Changes
NCQA’s updates focus on a faster, more proactive credentialing process that leverages modern, innovative technology. Here’s what that means for you:
1 – Shorter verification windows
One significant change is the shortened verification window. Organizations seeking credentialing accreditation or health plan accreditation will now need to verify credentials within 120 days instead of 180. For credentialing certification, the timeframe is reduced from 120 days to 90 days.
This accelerated timeline demands faster, streamlined workflows—manual processes won’t keep up.
2 – New ongoing monitoring criteria
Ongoing monitoring requirements are expanding as well. Organizations must now track license expiration dates on a monthly basis. In addition, Medicare and Medicaid sanctions and exclusions and SAM.gov checks must occur at least every 30 days.
Findings from these checks must be shared with a designated peer-review body beyond the credentialing committee. This change reflects NCQA’s push toward continuous monitoring, reducing risks that can arise between credentialing cycles.
3 – Updates to credentialing application
Credentialing applications also have new requirements. Providers must now include race, ethnicity, and language information as part of the application (though completing these fields remains voluntary). Additionally, NCQA now requires a non-discrimination statement to be included. These updates align with the industry’s growing focus on equity and access.
4 – Aligning system control requirements with information integrity standards
NCQA has also expanded its information integrity standards. This includes clearer definitions, improved system controls, and new training protocols to ensure data accuracy and compliance. These updates require a closer review of how credentialing data is stored, accessed, and maintained.
5 – Revisions to credentialing program structure
Lastly, NCQA is updating its credentialing program design. Credentialing certification now spans three years (instead of two) with a three year look-back period.
Scoring is now aligned with health plan accreditation, with outcomes labeled “Met,” “Partially Met,” or “Not Met.” This simplified scoring model makes it easier for organizations to track their standing.
How Andros Can Help
NCQA’s updates present a valuable opportunity to improve credentialing processes, while introducing new challenges. These changes reflect the industry’s shift toward a faster, more proactive approach. At Andros, we’re helping clients streamline workflows, enhance data accuracy, and adopt technology-driven solutions to stay ahead of the deadline.
July 1, 2025, is fast approaching. Don’t wait to assess your processes! Reach out today and Andros can help you build a strategy that ensures compliance while improving efficiency. Let’s talk about how you can meet NCQA’s new standards with confidence.
