About this summary. NCQA’s standards are proprietary and updated regularly. This page describes them at a high level from NCQA’s public materials, mainly its September 2025 guide to its credentialing programs. For requirements you will be surveyed against, use the current standards from NCQA.
What NCQA is and why it matters for credentialing
The National Committee for Quality Assurance (NCQA) accredits health plans and other healthcare organizations. Its credentialing standards describe how an organization should check that practitioners are qualified before they join a network, and keep checking afterwards. Health plans that are NCQA accredited must credential practitioners to these standards, and they often expect any organization they delegate credentialing to, including CVOs and credentialing agencies, to meet them too.
Accreditation vs Certification
| Credentialing Accreditation | Credentialing Certification | |
|---|---|---|
| For | Organizations that provide the full scope of credentialing: verification, a credentialing committee, decisions and ongoing monitoring. | Credentials verification organizations (CVOs) that verify credentials and report the results to their clients. |
| Scope | The whole credentialing program, including committee review and practitioner rights. | Verification services, certified individually. NCQA lists 11 certification options, from license to practice to ongoing monitoring of sanctions. |
| Status | Three-year status, with interim and provisional options. | Three-year survey cycle. |
The main areas the standards cover
NCQA’s comparison of the two programs groups the requirements into these categories:
- Internal quality improvement of the credentialing operation.
- Information integrity: protecting credentialing information from unauthorized changes.
- Policies and procedures for evaluating and selecting practitioners.
- The application and its attestation content.
- Credentialing verification of each required element, from acceptable sources, within time limits.
- Recredentialing on a fixed cycle.
- Delegation: oversight of any credentialing work done by another organization.
- Credentialing committee peer review of decisions (Accreditation).
- Practitioner rights, such as notification and the right to correct information (Accreditation).
- Assessment of organizational providers such as hospitals and facilities (Accreditation).
Between cycles, NCQA’s guide describes monthly monitoring of practitioner sanctions, license expiration, complaints and quality issues, and taking action when something is found.
Verification time limits
Each verified element must be no older than a set number of days when the credentialing decision is made. NCQA’s September 2025 guide lists these timeframes:
| Element | Credentialing Accreditation | Credentialing Certification |
|---|---|---|
| License to practice | 180 days | 90 days |
| Board certification | 120 days | 90 days |
| Work history | 180 days | 120 days |
| Malpractice history | 120 days | 90 days |
| State licensing sanctions | 120 days | 90 days |
| Medicare/Medicaid sanctions | 120 days | 90 days |
| Application attestation | 180 days | 120 days |
| Medicare/Medicaid exclusions | 120 days | 90 days |
Source: NCQA, A Comprehensive Guide to NCQA Credentialing Programs, September 2025, “Verification Timeframes”. Time limits have changed in recent standard years and can differ for health plan accreditation; check the standards for your program and year.
Recredentialing: at least every 36 months
Practitioners must be recredentialed at least every 36 months. NCQA has stated that organizations cannot extend the cycle, with narrow exceptions such as active military duty or medical leave, and that a practitioner not recredentialed within 36 months counts against the organization (NCQA FAQ). Our guide to recredentialing cycles covers how this sits alongside Medicare and Medicaid revalidation.
Delegation and automatic credit
A health plan can delegate credentialing to another organization, such as a medical group, a CVO or a credentialing agency, but it stays responsible for the work. It oversees the delegate through an agreement, reporting and periodic audits of files. When the delegate holds the relevant NCQA Accreditation or Certification, the plan can receive automatic credit for some of that oversight, which is one reason delegates pursue NCQA status.
What this means day to day
- Use one written checklist per provider type, and follow it every time
- Verify close to the decision so nothing ages past its time limit
- Record source, date, method and verifier for every element
- Explain every discrepancy and work-history gap in writing
- Keep committee or designee decisions, with dates, in the file
- Start recredentialing early enough to finish inside 36 months
- Monitor sanctions and expirations between cycles
How Credentik supports NCQA-style credentialing
Credentik’s verification checklist gives each element a validity window, records the source, method, verifier and evidence, and refuses a decision while a required element is pending, expired or an unexplained discrepancy. Files route to clean-file sign-off or committee, recredentialing cycles open early, and a delegation audit portal lets health-plan auditors review sampled files. Credentik is software; it does not grant NCQA status.