General NCQA
NCQA stand for
National Committee for Quality Assurance
2025 NCQA Credentialing changes mainly include
Primary source verification timelines
Medicare & Medicaid sanctions and exclusions; and SAM must be monitored
Monthly
Information about medical school/graduate degree and post-graduate training falls under this category
Education and Training
Verifiable uses this organization to collect and manage professional information
CAQH
True or False: Verifiable is NCQA Accredited
False
Certified credentialing organizations must make a final decision on a practitioner within
90 days
Verifiable monitors this source continuously
NPDB
A minimum of this many years of relevant work history must be obtained
Five
A CAQH account must have been attested within the past this many days prior to application
120 Days
3 entities that can earn an accreditation with NCQA related to credentialing are
CVOs, Health Plans, Provider Groups
Accredited health plans must make a final decision on a practitioner within
120 days
The credentialing process will be performed at least every this many months for recredentialing
36 months
A minimum of this many years of relevant work history must be obtained
5 Years
This form may be signed by initial and recredentialing applicants in addition to the CAQH application
Verifiable's Practitioner Credentialing Authorization Form
NCQA was founded in
1990
Verifiable partnered with Humana to reduced credentialing turnaround times by
98%
health plan face financial risks, reputational loss and ______ by not monitoring their provider networks to the NCQA standard
Loss of NCQA Accreditation
State License and/or certification is verified via this method
Primary Sources
All applications are evaluated for completeness within this many business days from the date of receipt.
30 Days
NCQA's mission is
To improve the quality of health care for all Americans
This individual approves the policy on an annual basis
Director of Credentialing Client Services
This large health plan is in talks with Verifiable to improve their monitoring systems ahead of the NCQA changes
Claritev
This questionnaire addresses areas such as the inability to perform essential functions, illegal drug use, history of license loss, felony convictions, and limitations of privileges or disciplinary activity
Disclosure Questionnaire
Verifiable will process accepted applications within this many days of notice
90 Days