NCQA Credentialing Standards 2025-2026: How Data Trust Scoring Supports Compliance
NCQA's updated credentialing standards effective July 2025 tighten primary source verification timelines and add continuous monitoring requirements. For health plans, compliance is not just about having the right processes. It is about being able to demonstrate those processes are working — with an auditable, defensible record.
NCQA's 2025-2026 credentialing standards represent the most significant update to primary source verification requirements in years. The changes tighten timelines, expand continuous monitoring obligations, and increase the evidentiary burden for demonstrating that provider data management processes meet accreditation standards.
For health plans and health systems, the compliance question is no longer just: do we have a credentialing process? It is: can we demonstrate that process produces trustworthy data, and can we prove it under audit?
What changed in 2025-2026
The updated NCQA standards introduce several materially significant changes:
Tighter PSV timelines: Primary source verification for initial credentialing must be completed within shortened windows. The practical effect is that credentialing teams cannot rely on batch verification cycles that leave records in pending states for extended periods.
Continuous monitoring expansion: Re-credentialing is no longer sufficient as a monitoring mechanism. NCQA's updated standards require ongoing monitoring of license status, sanctions, and exclusions — not just at the two-year re-credentialing cycle but continuously, with documented processes for how monitoring is conducted and how exceptions are handled.
Expanded source requirements: The list of primary sources that constitute acceptable verification has been clarified and expanded, with explicit requirements for source reliability documentation.
Taken together, these changes shift the compliance burden from having a credentialing program to demonstrating that the program produces reliable, current, documented results.
The three compliance gaps these standards expose
Most health plans have credentialing processes that were built to satisfy the previous generation of NCQA requirements. The 2025-2026 updates expose three specific gaps:
Gap 1: Timestamp granularity
The tighter PSV timelines require documentation that verification occurred within specified windows. For many plans, the credentialing record shows a verification date but not the source-level timestamp documenting when each primary source was accessed. Under an NCQA audit, the question will be: when exactly was this specific license verified against this specific source?
SuperTruth's IntegrityNet captures that timestamp at ingestion, at the field level. The audit trail includes source identity, access time, and the captured value at that moment — not just a summary verification date.
Gap 2: Monitoring documentation
Continuous monitoring requires not just that monitoring occurs but that there is a documented process and a record of what was monitored, when, and what was found. For plans using periodic batch verification, the monitoring record shows updates — it does not show the continuous monitoring process required under the new standards.
The DTI Recency dimension provides exactly this. Every record carries a decaying recency score that reflects elapsed time since last verification. The score is calculated continuously, not on a batch schedule. When a record's recency score falls below a threshold, it surfaces for reverification. The monitoring history is the score history.
Gap 3: Concordance documentation
When multiple primary sources disagree — the state licensing board shows one specialty, the NPI registry shows another, CAQH shows a third — the NCQA-compliant process requires that the discordance be identified, investigated, and resolved with documentation. Most credentialing systems flag exceptions but do not systematically score the degree of agreement across sources.
The DTI Concordance dimension does exactly this. When independent sources agree, the concordance score is high. When they disagree, the discordance is flagged with a score, a timestamp, and the specific sources in conflict. The documentation is automatic.
What a trust-scored provider record looks like under audit
An NCQA auditor reviewing a provider record in a trust-scored system would see:
This is the kind of documentation that transforms an NCQA audit from an adversarial process into a demonstration of competence.
The practical path
SuperTruth's IntegrityNet integrates with existing credentialing workflows. The zero-copy architecture means provider data stays in the health plan's existing systems. IntegrityNet reads from those systems, scores every record through the DTI Engine, and returns a trust score with dimensional breakdown that can be attached to the existing record in any format the credentialing system accepts.
The result is the same credentialing workflow the team already runs, with a trust layer added that produces the documentation NCQA's updated standards require.
Further reading: See our approach for health plans For health plans preparing for 2025-2026 NCQA accreditation review, the window to build that documentation layer is narrowing. Reach Louis Simeonidis at louis@supertruth.ai or (215) 918-4140 to discuss what this looks like for your organization.
Jason Alan Snyder
Co-founder of SuperTruth and Artists & Robots, and an inventor on the Data Trust Index patents. Twenty-plus years building technology inside Interpublic Group. He writes here nearly every day on data trust, provenance, and what AI should be allowed to act on, and publishes essays on his Substack.
About SuperTruth · LinkedIn · Substack · jasonalansnyder.com
See it in practice
Provider data that holds up under NCQA audit.
DTI scoring for credentialing, CMS CRUSH, and No Surprises Act.