NCQA’s 2025 Credentialing Changes: What Healthcare Practices Need to Know and How to Stay Compliant

Alicia Shickle
May 20
2 min read

Starting July 1, 2025, the National Committee for Quality Assurance (NCQA) will implement updated credentialing standards that mandate monthly monitoring of provider license expiration dates.

This change is part of NCQA's broader initiative to enhance ongoing oversight and ensure continuous compliance throughout a provider's credentialing cycle.

🔍 Key Requirements

Monthly License Expiration Tracking: Organizations must verify the expiration dates of all licensed practitioners' credentials on a monthly basis. This ensures that providers maintain active and valid licenses at all times.
Timely Response to Expirations: If a license is found to be expired, organizations are required to address the issue within a 30-day window to remain compliant.
Expanded Ongoing Monitoring: Beyond license tracking, NCQA now requires monthly checks for Medicare and Medicaid sanctions and exclusions, including verification through SAM.gov.

⚠️ Compliance Implications

Failure to adhere to these updated standards can lead to:

Operational Disruptions: Providers with expired licenses may be temporarily barred from practicing, affecting patient care and organizational operations.
Financial Penalties: Non-compliance can result in fines and increased scrutiny from regulatory bodies.
Reputational Risk: Maintaining up-to-date credentials is crucial for organizational credibility and trust with patients and partners.

✅ Recommended Actions

To prepare for these changes:

Implement Automated Monitoring Systems: Utilize credentialing software that can automatically track license expirations and send alerts for upcoming renewals.
Establish Clear Protocols: Develop internal processes to address expired licenses promptly within the stipulated 30-day period.
Regularly Review Compliance Policies: Ensure that your organization's credentialing policies are updated to reflect NCQA's new requirements.

For detailed information on these updates, refer to NCQA's official documentation: NCQA.

🛠️ How We Can Help

At ProCode Compliance Solutions, we offer tailored credentialing support services designed to help small to mid-sized practices meet the new NCQA standards with confidence. Our team can help! Click here for our full suite of credentialing services: https://www.procodecs.com/credentialing

Whether you need full credentialing management or supplemental support to enhance your internal processes, we’re here to reduce your risk, save you time, and keep your practice audit-ready.