Implementing NCQA’s July 1, 2025 Rules: Automated Credentialing for Full Compliance

At ACCORDPRO, we help clinics and health systems meet NCQA standards through modern, automated credentialing solutions that cut manual work and reduce human error. Here’s what you need to know about the 2025 rules—and how automation keeps you compliant.

How to Keep Your Practice Aligned With the Latest Standards

Starting July 1, 2025, the National Committee for Quality Assurance (NCQA) is rolling out new requirements that raise the bar for how healthcare organizations handle credentialing and recredentialing. Practices that don’t adapt risk falling out of compliance with payer contracts, losing accreditation, or facing costly delays in provider onboarding.

What’s Changing Under NCQA’s 2025 Rules

The new rules emphasize timeliness, primary source verification, and the use of secure technology to reduce administrative burdens and data errors. Major updates include:

• Shorter Verification Windows: NCQA now expects organizations to verify credentials and complete credentialing files within stricter timeframes.

• Mandatory Audit Trails: Digital audit trails must show clear records of who verified what, when, and how—manual spreadsheets won’t cut it anymore.

• Updated Requirements for Delegated Entities: Practices that outsource parts of their credentialing must prove their vendors follow NCQA standards and maintain real-time status updates.

• Emphasis on Ongoing Monitoring: Continuous monitoring of licenses, sanctions, and exclusions must be built into your process—not handled as a once-every-3-years task.

Why Manual Credentialing Puts You at Risk

Manual spreadsheets, scattered files, and inconsistent follow-ups are recipes for non-compliance. Many organizations miss deadlines, lose track of expiring licenses, or fail to produce audit-ready records when payers ask.

Non-compliance can mean:

• Lost contracts with payers that require NCQA-aligned credentialing

• Payment delays for new providers waiting to see patients

• Failed re-accreditation with higher operational costs to fix gaps

How Automated Credentialing Keeps You Compliant

Modern credentialing software and service partners like ACCORDPRO help practices:

• Verify Faster: Automate primary source verification for licenses, board certifications, DEA, NPIs, and sanctions.

• Track Expirables in Real Time: Get alerts for upcoming expirations and handle renewals proactively.

• Maintain Complete Digital Audit Trails: Document every action, timestamp, and verification step for full NCQA readiness.

• Centralize Provider Data: Store all credentials in a secure, cloud-based portal—no more scattered files or outdated spreadsheets.

• Stay Ready for Delegated Audits: Show health plans that your process aligns with NCQA’s delegated credentialing requirements, with clear policies and real-time reporting.

Steps to Implement an Automated Credentialing Process by July 1, 2025

1. Audit Your Current Credentialing Workflow 

Identify gaps, redundant tasks, and manual steps that increase error risk.

2. Digitize Provider Data 

Move credentials, documents, and logs into a secure, centralized system.

3. Automate Primary Source Checks 

Use verified tools or partner services to complete checks faster and with full documentation.

4. Set Up Ongoing Monitoring 

Implement continuous license monitoring and exclusion checks to stay NCQA-compliant year-round.

5. Train Your Team or Outsource 

Equip your staff to manage the new process—or let ACCORDPRO handle credentialing for you so you can focus on patient care.

Final Thoughts

The NCQA’s July 1, 2025 rules raise the credentialing bar—but with the right tools and partners, staying compliant doesn’t have to be a headache. Automation cuts errors, protects your payer relationships, and speeds up provider onboarding.

ACCORDPRO delivers complete credentialing and recredentialing support that aligns with NCQA’s evolving standards—without the stress of manual tracking.

Ready to upgrade your credentialing process before the new rules hit?

📞 Contact us at 425-215-0517 or visit www.accordpros.com to schedule a free compliance readiness call.