NCQA guidelines centering on credentialing and network monitoring are changing in 2025. If your organization depends largely on the services of a CVO (credentials verification organization) to conduct credentialing and network monitoring, whether or not they can meet these guidelines will have an effect on your provider network.
This year isn’t a one-off, either; NCQA guidelines are subject to further updates in the future, which means your CVO has to look for ways to evolve and improve to meet changing industry standards. Relying on outdated, largely manual legacy systems makes meeting these standards more difficult. With the right systems and resources in place, you can achieve peak efficiency and quality.
Evaluate your CVO team’s efficiency and performance using these five questions as a benchmark. If your team can’t meet current or future standards, it might be time to switch things up.
1. Can you see real-time progress?
Clarity throughout the credentialing process is essential. Real-time insight removes the guesswork and allows your team to proactively resolve issues or errors that might otherwise remain unnoticed.
Checking the status of your provider credentialing process in real-time not only allows you to nip potential issues in the bud, but also provides your organization with a competitive advantage: efficient, error-free credentialing allows you to onboard providers more quickly, reducing time to revenue.
2. Are self-serve reports available?
Finding areas for improvement without in-depth insight into your current-state operations can be challenging. Self-serve reporting and comprehensive audit tracking allows your team to analyze CVO performance, anticipate credentialing events and actions, and track whether or not your compliance program is adhering to all defined NCQA guidelines.
3. What is their average credentialing turnaround time?
Reduced verification timelines are coming — is your CVO capable of meeting them?Currently, both certified and accredited organizations verify a practitioner’s:
- Licensure
- Board certification
- History of work and malpractice
- State licensing sanctions
- Medicare/Medicaid sanctions
Once verifications are finished, certified credentialing organizations must make a final decision on a practitioner within 120 days; for accredited health plans, the timeframe is 180 days. Those timeframes are decreasing significantly in 2025. Certified credentialing organizations now only have 90 days; accredited health plans have just 120 days.
Tighter timelines bring more pressure; over-reliance on manual processes and legacy systems (especially when tasked with pulling information from multiple and unorganized data sources) could leave your CVO team scrambling if necessary changes aren’t made.
4. Do they ensure quality with every file?
Reliably clean files — checked against NCQA and your specific organizational standards — are essential for not only passing audits with ease, but ensuring your credentialing process moves quickly and without any setbacks (and meets the updated timelines). A well-defined and documented quality assurance process can go a long way toward mitigating future issues.
5. Does your CVO provide dedicated account support?
If there’s an issue with your credentialing process, do you know who to call? Much like how disparate data sources can lead to confusion and errors, lacking a single point of contact on your CVO team can cause miscommunication issues — and leave you unaware of where you stand.
Choose your ideal CVO team
Your organization is unique — shouldn’t your CVO team reflect your exact needs? Verifiable offers three distinct CVO packages, with customizable solutions designed to maximize organizational alignment and meet all NCQA guidelines. Find Your CVO.
Looking for a new CVO? Start here.
