Credentialing as a Network Performance Lever: Key Takeaways from the NCQA & Verifiable Webinar

Hosted by NCQA in partnership with Verifiable and Blue Cross Blue Shield of North Carolina

Originally recorded on April 30, 2026, published by NCQA: Watch the full recording

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For too long, credentialing has been treated as a cost of doing business; a necessary but largely invisible back-office function. A recent webinar hosted by NCQA, featuring Verifiable and Blue Cross Blue Shield of North Carolina, made the case for something more ambitious: credentialing as a strategic lever for network performance, patient access, and provider experience.

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Here's what you need to know.

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What's Changed: NCQA's Updated Standards (Effective July 2025)

NCQA's Tsveta Polhemus opened the session by grounding the conversation in why credentialing standards are evolving and why it matters for patients, clinicians, and organizations alike.

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The July 2025 updates focus on three core areas:

• Faster verification timeframes. The window to complete primary source verifications has narrowed, with the goal of having the freshest possible data at the point of credentialing decisions.
• Strengthened ongoing monitoring. Organizations must now review specified information from NCQA-approved sources at least every 30 calendar days for their entire network and report any findings to a credentialing committee or designated peer review body.
• Stronger information integrity requirements. Documentation, traceability, and audit readiness are no longer optional niceties. They're core expectations.

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The bottom line: timeliness, repeatability, and documentation are no longer best practices — they're requirements.

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The Broken Equation in Credentialing Operations

Janan Dave, SVP of Operations at Verifiable and leader of their NCQA-certified CVO, named the structural problem directly:

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Volume = Headcount. Quality = Added Cost. Complexity = Added Risk.

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This equation is unsustainable in an environment of thin margins, evolving regulations, and high expectations around both provider and member experience.

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Her prescription? Rethink who does what. Credentialing specialists should be spending the bulk of their time on the 20–30% of providers with actual risk or complexity, not on data entry, rework, or chasing down missing information.

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How Technology Is Changing the Work: From APIs to Agentic AI

Verifiable's approach has evolved in three stages:

1. API-first infrastructure. By connecting directly to primary sources in real time, provider data becomes systematized, auditable, and continuously maintained.
2. Semi-automated credentialing workflows. Configurable rules, reduced manual entry, and greater visibility dramatically cut the time per provider and reduce human error.
3. CreditAgent: Agentic AI. The newest frontier: an AI agent that can process thousands of credentialing tasks in parallel, operating 24/7, and only escalating to a human when there's something that genuinely needs review.

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Brett Dooies, Head of Product at Verifiable, illustrated the impact with a real time study: where a highly efficient specialist might complete 9–10 providers over the course of an hour (averaging 6–9 minutes each), CreditAgent can move that same batch through in under 10 minutes — in parallel, overnight, without anyone waiting for Monday morning.

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The key design principle: automation handles the routine, humans own the judgment calls. Every escalation is deliberate. Every decision is traceable.

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A Health Plan Perspective: Blue Cross Blue Shield of North Carolina

Danny Zajac, Principal Strategic Adviser at BCBS NC, offered a candid look at what it takes to actually transform credentialing at a large health plan.

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The honest starting point: Nothing was catastrophically broken. But the organization wasn't agile enough to adapt quickly, the provider experience had room to improve, and the data architecture underlying credentialing couldn't scale to where they needed to go.

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His team's rallying cry became: "The current state is not the model for our future state."

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Key principles that shaped their transformation approach:

• People first. Before process or technology, the team mindset and skill set had to evolve. Buy-in can't be mandated — it has to be built.
• Reduce data fragmentation. Operating out of many systems created compounding problems. The goal: cohesion across provider enrollment, credentialing, contracting, and data maintenance.
• Portal to payment visibility. Every stakeholder, internal and external, should be able to see exactly where a provider stands in the process, without having to ask.

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His analogy for where healthcare needs to go: "I want the car rental place to know my flight was delayed. I want the right car I ordered six months ago to be ready." No surprises. No having to re-explain yourself at every step.

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BCBS NC is currently in the business acceptance testing phase and on track to launch in their new system by end of year. Early expectations include meaningfully faster end-to-end onboarding times and significant reductions in manual entry and rework.

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Nonnegotiables for Accountability in an AI-Powered Future

Perhaps the most important part of the conversation was the frank discussion about what cannot be automated — and what accountability looks like when AI is doing more of the work.

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The panelists converged on several principles:

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Human oversight at critical decision points is non-negotiable. The accountability for credentialing decisions sits with the organization. Technology can move information faster and flag issues more reliably, but the final sign-off must remain with a human who understands what they're approving.

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Audit readiness must be built in, not bolted on. As Janan noted, "Preparing for audits is not a last-minute scramble. It has to be ingrained in your policies and operations day to day." That means clear documentation of what the system reviewed, what it found, and how decisions were escalated.

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Avoid diffused accountability. One of the subtle risks of automation is the tendency to assume the software "handled it." Verifiable has worked to counter this by giving credentialing specialists full visibility into what the agent reviewed and why — so the human taking ownership actually knows what they're owning.

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Define escalation paths before you need them. What happens when the system doesn't have what it needs? Who intervenes? How fast? These shouldn't be discovered in the moment.

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Process changes still require human management. Technology enables speed, but updating a workflow in an automated system can sometimes be slower than telling a team about a policy change. Designing for adaptability from the start matters.

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What This Means for Your Organization

Whether you're a health plan, CVO, or credentialing team evaluating where to go next, the message from this session is consistent:

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• Credentialing is strategic, not administrative. It directly affects patient access, provider experience, network quality, and compliance.
• The standards are moving. The July 2025 NCQA updates aren't a distant future — they're here. Organizations that haven't aligned their operations and documentation practices need to start now.
• AI and automation are real tools, not hype, but they require thoughtful implementation. The goal is to make human experts faster and better, not to remove them from the equation.
• Change management is half the battle. Technology is only part of the transformation. The organizations seeing results are the ones that invested equally in people, process, and platform.

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This post summarizes content from a recorded NCQA webinar. Standards referenced are a snapshot only — visit NCQA's website for the complete set of current requirements.