With NCQA tightening provider credentialing and monitoring standards on July 1, 2025, healthcare organizations must ensure compliance with the updated license verification and proactive monitoring timelines. Manual tracking increases the risk of compliance gaps, penalties and accreditation delays.

This quick-reference checklist outlines the five essential steps to meet NCQA’s new requirements. Download a copy of the checklist here.

1. Centralize data

Conduct an internal audit of current licensure records. Consolidate data into a single source of truth for better visibility.

2. Automate verifications

Implement AI-driven monitoring tools for real-time compliance, and set up automated alerts for expiring credentials.

3. Rapid responsiveness

Create a workflow for addressing expirations within NCQA’s 30-day window, and assign clear roles and responsibilities within compliance teams.

4. Train team

Provide ongoing training sessions to keep teams informed. Schedule quarterly refreshers to maintain compliance alignment.

5. Use AI-powered credentialing

For continuous compliance, monitor provider licenses in real time to avoid lapses. Ensure workflows stay up-to-date to keep ahead of regulatory changes.

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