Navigating NCQA’s 2025 Credentialing & Monitoring Requirements
What You Need to Know:
The National Committee for Quality Assurance (NCQA) has announced significant updates to its credentialing and monitoring requirements, effective July 1, 2025. These changes are designed to enhance patient safety, data accuracy, and compliance efficiency for health plans. Key updates include:
- Shortened verification timeframes
- Stricter ongoing monitoring
- Enhanced information integrity standards
To remain compliant, healthcare organizations must accelerate credentialing verification, implement continuous monitoring systems, and strengthen data security.
At Verisys, we specialize in credentialing and license monitoring, offering industry-leading data accuracy and real-time insights. Verisys Licensure solution ensures seamless compliance with the new NCQA standards, keeping your organization ahead of regulatory changes.
Key NCQA 2025 Compliance Changes
1. Shortened Verification Timeframes
- Credentialing Accreditation & Health Plan Accreditation: Reduced from 180 days to 120 days
- Credentialing Certification: Verification now required within 90 days instead of 120 days
- This applies to licenses, board certifications, and work history
2. Stricter Ongoing Monitoring Requirements
- Monthly exclusions checks: Required every 30 days across Medicare, Medicaid, and SAM.gov
- Real-time license expiration tracking: Continuous monitoring to prevent compliance lapses
3. Enhanced Credentialing Application Requirements
- Shortened attestation timeframes for practitioners
- Expanded demographic data collection (race, ethnicity, languages spoken)
- Mandatory non-discriminatory statement to promote health equity
How Verisys Helps You Stay Compliant
With NCQA’s 2025 changes, organizations need a trusted partner for credentialing and monitoring. Verisys has helped leading healthcare organizations stay ahead of regulatory updates by implementing automated credentialing and real-time monitoring.
Verisys has a proven track record of supporting compliance efforts across healthcare organizations. Learn more in our article on the importance of NCQA certification for CVOs. Our expertise enables organizations to navigate regulatory changes with real-time data insights and proactive monitoring solutions.
Verisys Licensure: Comprehensive Credentialing & Monitoring Solution
- Covers all license types across all U.S. jurisdictions
- Tracks both current and historical sanctions
- Offers fast, seamless implementation
- Provides real-time license expiration monitoring to meet NCQA’s new standards
- Ensures continuous exclusions and sanctions tracking
The Verisys Advantage: 40% More Actionable Data
Compared to competitors, Verisys delivers 40% more actionable insights through:
- Faster data updates for real-time decision-making
- More comprehensive provider history tracking
- Seamless integration with existing compliance workflows
This ensures:
- Proactive license renewal tracking, reducing non-compliance risk
- Early detection of historical and current sanctions, identifying risks faster
With Verisys, your organization can seamlessly adapt to these regulatory changes, ensuring compliance, efficiency, and operational excellence.
Ensure Your Credentialing & Monitoring Processes Are NCQA-Ready
With Verisys, your organization can seamlessly adapt to these regulatory changes, ensuring compliance and operational excellence. With Verisys’ industry-leading credentialing and monitoring solutions, you can stay ahead of NCQA’s 2025 updates.
