NCQA credentialing standards 2025: What’s the hype – and why should you care?

It is common for healthcare industries and therapy fields to undergo various changes and updates every year, such as the NCQA credentialing standards 2025. Often, therapy providers tend to oversee credentialing processes due to their daunting nature. While credentialing takes longer, it is essential to consider the process for your practice and providers.

Credentialing can protect your patient and practice safety, ensure quality therapy care, speed up reimbursements, prevent claim denials and delays, and enhance RCM. With the new NCQA standards and guidelines, you can streamline credentialing, track data in detail, and address any requirements that might arise.

In this blog, we will cover everything about the NCQA credentialing standards 2025, benefits, best practices, and how TherapyPM can make credentialing easier for you!

What are the NCQA Standards for Credentialing?

The National Committee of Quality Assurance (NCQA) is a private, non-profit organization that was founded in 1990. The NCQA credentialing standards measure health plans and accredit them to ensure accountability and transparency in therapy practices, and to avoid malpractice. 

Particularly, the Health Plan Accreditation program focuses on provider credentialing, controlling costs, and adhering to the government and purchaser requirements. Patients place their trust in providers to provide the best therapy service; therefore, they must ensure compliance with the NCQA standards and guidelines.

Impact of NCQA Credentialing Standards	Why Does It Matter?
Reimbursement	Ensures clean claims.Reduces denials. Speeds up payments by up to 30%.
Patient Trust	Highlights quality and credibility. Boosts patient confidence and referrals.
Organizational Credibility	Enhances practice reputation.Proves authentic for payers, partners, and value-based care contracts.
Risk Mitigation	Safeguards your practice and providers against audits, fines, and network exclusions.

Pro Tip:

An automated EHR or PMS platform like TherapyPM can streamline your credentialing process in line with the NCQA credentialing standards, while maintaining compliance with HIPAA and other regulatory bodies.

Why are These NCQA Credentialing Changes Happening in 2025?

NCQA had to undergo new credentialing changes in 2025 in order to encourage industry evolution, meet regulatory demands, and lean towards modern therapy care solutions.

Here are some reasons why the 2025 NCQA credentialing guideline updates came into effect:

Reason #1: Shift to Digital & Automated Systems

NCQA strives to reduce paper-based processes and leans towards automated, data-driven credentialing standards. This reflects how the industry has embraced technology and innovation.

Impact on Providers:

1. Faster verification
2. Reduced errors
3. Streamlined workflows for providers and organizations.

Reason #2: Regulatory & Market Alignment

NCQA credentialing updates 2025 align with changing state/federal regulations and stakeholder needs. It ensures practices can deliver high-quality care while staying compliant.

Impact on Providers:

1. Helps providers avoid penalties.
2. Maintains accreditation with changing standards.

Reason #3: Patient Safety & Equity

New NCQA credentialing standards emphasize quality, transparency, and continuous monitoring of provider credentials. It includes voluntary collection of demographic data – race, language, ethnicity, and more.

Impact on Providers:

1. Supports inclusive care
2. Improves visibility into the provider landscape.

Reason #4: Faster Verification Timelines

Verification windows are shortened to 90-120 days (previously 120-180 days), ensuring real-time oversight and up-to-date provider data.

Impact on Providers:

1. Requires providers to adopt efficient systems to meet tighter deadlines and reduce compliance risks.

Reason #5: Industry Feedback & Innovation

NCQA has gathered input from public comments, surveys, and industry forums to address challenges like administrative burdens and data integrity issues.

Impact on Providers:

1. Ensures updates are practical, actionable, and beneficial for all practices.

Key Changes in NCQA Credentialing Standards 2025

The latest NCQA guidelines and standards can add new layers to credentialing in 2025, making it harder for providers to overlook them.

Here are some key NCQA credentialing standards 2025 that can help you and your teams make well-informed decisions:

Key Change #1: Primary Source Verification (PSV)

What’s New?

1. Faster Verification: For files credentialed on or after July 1st, 2025, primary source verification must be completed within 120 days. Previously, it was a 180-day limit.
2. Stricter Exclusion Checks: Practices must now verify whether therapy providers are excluded from Medicare and Medicaid programs, while checking for sanctions.
3. Grandfather Clause: Files credentialed or recredentialed before July 1, 2025, will still follow the old rules.

Why Does It Matter?

1. It ensures up-to-date and accurate provider credentials.
2. It reduces the risks of employing excluded or sanctioned therapy providers.
3. It aligns with NCQA’s credentialing standard for faster and efficient credentialing.

Key Change #2: Monthly Exclusions Checks

What’s New?

1. Therapy practices must now check for Medicare, Medicaid, and SAM.gov exclusions every 30 days, rather than less frequent reviews.
2. Findings must be shared with both the credentialing committee and a designated peer-review body.

Why Does It Matter?

1. It ensures no sanctioned providers slip through the cracks.
2. It protects your practice from compliance risks and financial penalties.

Key Change #3: Real-time License Expiration Tracking

What’s New?

1. Monthly Monitoring: The new NCQA credentialing standard involves continuous monitoring of license expirations, instead of monitoring just once every three years.
2. Monthly Expiration Checks: Licenses must be reviewed monthly, and expired credentials must be addressed within 30 days.

Why Does It Matter?

1. It prevents lapses in provider credentials, which can negatively affect care or slow down reimbursements.
2. It keeps your therapy practice compliant and audit-ready at all times.

Key Change #4: Information Integrity

What’s New?

1. Provider Credentialing Data: Practices must implement robust systems to protect the integrity of credentialing information – audit logs and secure documentation. They must monitor data consistently with clear protocols to reduce errors and check accuracy.
2. Training and Accountability: Credentialing teams must get regular training on information integrity – how to handle, verify, and protect sensitive provider data. Practices must document training and track compliance with these standards. 
3. Audit and Improvement: Practices must conduct regular audits and analyses of credentialing data to identify gaps or errors. They must take corrective actions in case they find any issues.

Why Does It Matter?

1. NCQA credentialing standards emphasize patient safety by allowing only qualified providers to deliver care and reduce risks.
2. Staying compliant with the NCQA credentialing standards   2025 can protect practices from audits, fines, or loss of accreditation from data errors or security breaches.
3. It instills confidence in payers, patients, and partners by demonstrating a commitment to transparency and reliability.

Key Change #5: Expanded Demographic Data

What’s New?

1. Optional Fields: NCQA’s updated credentialing standards now require organizations to include optional fields for race, ethnicity, and language data on applications.

Why Does It Matter?

1. It supports equity and inclusivity in therapy practices by improving visibility into the provider diversity.
2. Therapy practices can identify gaps and tailor programs to better serve diverse patient populations.

Key Change #6: Non-discriminatory Statement

What’s New?

• NCQA credentialing standards now require practices to include a clear, written, non-discriminatory statement for their credentialing policies and processes.

Why Does It Matter?

• It ensures fair and unbiased credentialing practices to reduce legal risks and promote equality.
• It reinforces your therapy practice’s commitment to inclusivity and compliance with anti-discrimination laws.

Key Change #7: Annual Audits and Training

What’s New?

1. Mandatory Annual Audits: NCQA now requires annual audits of credentialing processes and regular training for credentialing teams.
2. Analyse Audit Results: Practices must analyse the results to identify gaps, barriers, and opportunities for improvement, while documenting follow-up actions.

For more information, please refer to Page 18 of this manual!

Why Does It Matter?

1. It ensures ongoing compliance with the NCQA credentialing standards to reduce the risk of errors and oversights.
2. It ensures credentialed teams stay updated with the best practices, regulatory changes, and data integrity protocols.
3. It promotes continuous improvement in credentialing efficiency and accuracy.

Key Change #8: Focus on Automation

What’s New?

1. NCQA’s credentialing standards of 2025 encourage the use of automation strongly to streamline credentialing processes – verification, monitoring, and reporting.
2. Practices must adopt technology-driven solutions to meet tighter verification timelines and reduce manual errors.

Why Does It Matter?

1. It speeds up credentailing by automating repetitive tasks – primary source verification (PSV) and exclusions checks.
2. It reduces administrative burden and human errors, ensuring compliance with NCQA’s stricter timelines.
3. It supports real-time monitoring of provider credentials to improve data accuracy and patient safety.

Impact of 2025 NCQA Credentialing Guidelines Updates on Providers

The new NCQA standards and guidelines bring about many changes, whether positive or negative. Providers may also undergo periods of stress, uncertainty, or denial, or they may feel happy about the new updates.

The table below highlights the opportunities and challenges of NCQA standards and guidelines updates in 2025:

Opportunities for Providers with 2025 NCQA Credentialing Standards:

What are They?	How They Benefit Providers?
Faster Network Access	Quicker primary source verification (PSV) and shorter credentialing windows can help providers onboard and practice sooner.
Increased Transparency	Providers can receive transparent and real-time updates regarding the status of their credentialing applications.
Broader Data Insights	Enhanced data capture helps practices understand provider qualifications and track credentials, allowing proactive compliance and safety measures.
Improved Provider Experience	Streamlined processes, reduced administrative burden, and clear communication can help in positive provider recruitment and retention.

Challenges for Providers with 2025 NCQA Credentialing Standards:

What are They?	How They Pose Challenges for Providers?
Shorter Verification Timelines	Reduced deadlines for primary source verification requires practices to streamline processes and increase efficiency to maintain compliance.
Stricter Ongoing Monitoring	Implementing monthly exclusion checks for Medicare, Medicaid, and SAM.gov, along with continuous tracking of license expirations demands robust and proactive oversight.
Technology and Infrastructure Demands	Practices must invest in advanced credentialing software like TherapyPM to automate tasks, centralize data, and ensure continuous monitoring and reporting.
Increased Administrative Burden	Managing credentialing for multiple health plans with unique schedules can increased admin stress, especially with demands from NCQA credentialing standard updates.
Telehealth Credentialing Complexity	Managing multi-state credentialing for telehealth providers requires careful adaptation to varying regulations.
Data Management & Privacy	Ensuring the security of sensitive provider data and maintaining data integrity requires updated tools and stricter adherence to regulations like HIPAA.
Collection of Demographic Data	Gathering new demographic data – race, ethnicity, and language, to promote health equity, and incorporating non-discrimination statements, requires updates to credentialing application forms and processes.

How to Prepare for the 2025 NCQA Credentialing Guidelines and Updates?

Therapy practices must adopt faster verification timelines, enhanced ongoing monitoring, and stronger data integrity protocols. Navigating through the 2025 NCQA credentialing guidelines can be stressful, and it is highly understandable.

However, here are some tips on how to prepare for the NCQA standards and guidelines:

Shorten Credential Verification Timelines

NCQA now requires credentialing verifications to be completed within 120 days (previously 180 days). For certification, the window is even shorter, down to 90 days.

Action:

1. Audit and streamline your workflows.
2. Prioritize tasks, update checklists, and automate bulk follow-ups to stay within the new timelines.

Implement Monthly Monitoring for Credentials

Practices must now monitor license expiration and check for Medicare/Medicaid sanctions & SAM.gov exclusions. Recredentialing must be done monthly rather than just once every three years.

Action:

1. Develop a calendar alert system or switch to a credentialing software like TherapyPM to flag expiring credentials automatically.

Update Credentialing Applications

New NCQA credentialing application standards include optional, but visible fields for race, ethnicity, and language proficiency, in addition to a non-discriminatory statement.

Action:

1. Update your application forms and CAQH profiles accordingly.
2. Train your staff to explain these fields clearly and concisely.

Strengthen Data Integrity & Internal Controls

NCQA now emphasizes rigorous standards for data handling, therefore, your credentialing system must record and monitor every change – who made it, when, and why. Staff should also get training every year to detect any inappropriate documentation and policies.

Action:

1. Implement audit trails.
2. Ensure your platform logs modifications accurately.
3. Conduct annual training sessions for all your credentialing staff.

Use the New “Interim Survey” Strategy

NCQA has introduced a 90-day interim survey, offering organizations a clear path towards full accreditation. Additionally, you can also test your credentialing systems earlier in the process.

Action:

1. Apply for the interim survey in case your practice or CVO is not currently accredited. It serves as a proactive compliance measure.

Benefits of Compliance with the NCQA Credentialing Guidelines (2025)

The NCQA credentialing guidelines of 2025 provides numerous benefits for your therapy practice. Here’s how:

Improved Patient Safety and High Quality Care

Verifying provider credentials strictly ensures that only highly qualified and competent providers can deliver care in your practice. This can reduce risk of errors and potential malpractice incidents.

Enhanced Patient Trust and Practice Reputation

Compliance with NCQA credentialing standards can instill trust and confidence in your patients, which in turn can help your practice build credibility with payers, regulators, and the community.

Streamlined Practice Operations

Following NCQA credentialing standards can reduce inefficiencies, prevent duplicate work, and ensure a smooth workflow for providers and staff. 

Financial Protection for Your Therapy Practice

Meeting NCQA 2025 credentialing requirements can help your practice avoid penalties, reimbursement delays, and claim denials. Credentialing and RCM goes hand in hand, therefore, any delays in credentialing can further delay claims, reimbursements, and profits for your practice.

Better Payer Relationships

Staying compliant with NCQA standards and guidelines increases the chances of getting noticed by more insurance companies and networks. This in turn makes it easier for your practice to secure contracts and maintain smooth credentialing with them.  

Well-Equipped Practice for the Future

Staying updates with NCQA credentialing standards can allow your practice to adapt quickly to new requirements, helping you achieve success in the long-term.

Stay Compliant with NCQA Credentialing Standards 2025 with TherapyPM

Credentialing used to be a lengthy and time-consuming process, but not anymore! In light of the 2025 NCQA credentialing updates, practices must consider switching to automated solutions to make their credentialing processes more efficient.

Additionally, managing administrative tasks as well as credentialing processes can pose additional burdens in a single day. This can significantly impact the quality of care you provide to patients, due to stress, burnout, and reduced time in a day.

How TherapyPM Meets NCQA Credentialing Standards?

NCQA 2025 Credentialing Updates	How TherapyPM Supports It?
Shortened Credentialing Timelines	Automates reminders, checklists, and document submissions so providers get paneled on time.
Ongoing Monitoring Requirements	Real-time alerts ensure you never miss an update. Flags expirations and compliance risks before they become problems.
Enhanced Applications with Demographic Data	Organizes and securely stores additional provider demographics securely. Makes it easier to submit complete applications without repeated back-and-forth with payers.
Single, Centralized Credentialing Program	Offers a centralized hub to store all documents, communications, and verifications. Keeps your practice audit-ready at all times.
Compliance Transparency	Maintains a digital audit trail for every step of the credentialing process. Helps your practice demonstrate compliance at any time with confidence.

Best Practices for Navigating the 2025 NCQA Credentialing Standards

To stay compliant with the new NCQA standards and avoid disruptions, therapy practices should adopt these best practices:

Audit Credentialing Workflows Regularly

Review processes quarterly to ensure they meet shortened NCQA credentialing timeframe and ongoing monitoring requirements.

Leverage Automation Tools

Use an automated credentialing software like TherapyPM to handle PSV, license monitoring, and recredentialing alerts to reduce manual errors.

Train Staff on Compliance

Provide annual training to admin and credentialing teams about updated NCQA credentialing requirements, including demographic data collection.

Maintain a Recredentialing Calendar

Track provider cycles proactively to avoid lapses that can impact reimbursement or patient care.

Ensure Strong Documentation

Keep audit-ready records of every credentialing step, from primary source verification to committee decisions.

Conclusion

The NCQA credentialing updates of 2025 set a higher bar for compliance and efficiency. While the changes may feel overwhelming, they ultimately aim to improve patient safety, provider accountability, and operational transparency. For therapy practices, success lies in being proactive, such as streamlining workflows, embracing automation, and aligning daily operations with compliance standards.

With TherapyPM, your practice can move beyond “just meeting” these new requirements to thriving under them. Simplify tracking, automate reminders, and ensure data accuracy to stay ahead of NCQA standards and guidelines expectations while focusing on what matters most – patient care.

Don’t let compliance challenges slow your practice down! Stay ahead of the NCQA 2025 updates with confidence. Get on a call with our credentialing expert to know how TherapyPM can ease your credentialing challenges. Book a Demo Now!