NCQA Credentialing Certification Consulting
Last updated: October 2026
NCQA Credentialing Certification (formerly NCQA CVO Certification) is the NCQA program for an organization that verifies the credentials of health care practitioners, and IHS helps Credentials Verification Organizations (CVOs) prepare for it by reviewing operations against the standards, drafting the policies and templates, and running mock reviews before NCQA's survey.
Integral Healthcare Solutions (IHS), founded in February 2002 by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC, supports this work as part of its NCQA practice. NCQA accreditation and recognition engagements are led by Maureen Plumstead. NCQA, a private nonprofit, governs the program and decides every outcome. NCQA's credentialing page now shows two tracks. Credentialing Accreditation is the track for organizations that make credentialing decisions through a committee. Credentialing Certification is the track for organizations that perform primary source verification (NCQA, Credentialing Accreditation and Certification Programs, page opened October 4, 2026). NCQA's former CVO Certification program address now redirects to that page.
Who is NCQA Credentialing Certification for?
It is for an organization that verifies practitioner credentials for health plans, managed behavioral health organizations, physician organizations or other health care organizations. NCQA's CVO Certification FAQ sets five eligibility conditions. Your organization needs a track record and insurance in place before it applies. NCQA requires at least six months of verification services before the application and verification work for at least 50% of contracted practitioners. It also requires errors and omissions insurance within the range it sets, and credentials records and procedures that let NCQA run the survey (NCQA CVO Certification FAQ, page opened October 4, 2026). The same FAQ says more than 90 organizations have earned the certification.
NCQA's Credentialing Accreditation FAQ adds a reason health plans and delegates pay attention to this program. NCQA's Credentialing Accreditation FAQ ties delegation to NCQA status. Once a credentialing organization hands off more than half of its verification work, each delegate it uses must itself hold NCQA Accreditation or Certification (NCQA Credentialing Accreditation FAQ, page opened October 4, 2026). A CVO that holds Certification can be that kind of delegate.
NCQA also publishes a map of states that require NCQA Health Plan Accreditation for Medicaid managed care (NCQA state map). Check whether the plans you serve are in those states.
If you want to build or restructure an internal credentialing program and are not pursuing certification, see Credentialing Program Design consulting. That work is led by Dr. Goddard.
What does NCQA Credentialing Certification assess?
NCQA's CVO FAQ lists three requirement areas: the internal quality improvement process, protecting credentialing information, and verifying credentials. It lists 11 certification options: License to Practice, State Licensing Board Sanctions, DEA or CDS Certification, Medicare/Medicaid Sanctions, Education and Training, Practitioner Application Processing, Board Certification Status, Application and Attestation Content, Work History, Ongoing Monitoring of Sanctions, and Malpractice Claims History (NCQA CVO Certification FAQ, page opened October 4, 2026). NCQA's Standards and Guidelines document, which holds the full standards, is sold in the NCQA Store.
What changed in the NCQA credentialing standards?
NCQA announced the 2025 credentialing updates on August 7, 2024. NCQA's news release describes three changes (NCQA, Updates to 2025 Credentialing Product Suite, page opened October 4, 2026):
- NCQA is moving Credentialing Accreditation and CVO Certification into a single credentialing program, with options for individual Certifications by function (License to Practice is one example) or an overall Accreditation. The release says this also lets organizations beyond traditional CVOs consider Credentialing Certification.
- NCQA shortened the verification timeframes.
- NCQA added an Interim Survey option that gives an organization a glide path to full Credentialing Accreditation within 18 months.
The release gives no day counts. Summaries published by credentialing technology vendors report that the primary source verification window for credentialing certification is now 90 days (Andros), that enrolled providers are checked every 30 days for federal exclusions and state sanctions (Assured), and that audit trails must record who changed data, what changed, when and why (Atlas Systems). These are secondary summaries. IHS checks each requirement against NCQA's Standards and Guidelines for the survey year your organization will use.
NCQA's credentialing page now lists 2027 resources for surveys with a start date of July 1, 2027 to June 30, 2028. Confirm which survey year applies to your timeline.
How does the NCQA Credentialing Certification process work?
NCQA's FAQ describes the sequence from first contact to decision. First comes an introductory call with NCQA staff. Your team then obtains the program documents and measures current practice against them. The application follows, and NCQA surveys once your operations match the standards. The FAQ puts the status decision within 30 days after NCQA finishes its review. NCQA puts the usual span from submitted application to decision at 12 months (NCQA CVO Certification FAQ, page opened October 4, 2026).
IHS adds its own preparation phases around that path. The month ranges below are IHS planning ranges for a first-time organization. They are not an NCQA schedule, and your timeline depends on how much of your operation already meets the standards.
| Phase (IHS planning range) | What IHS drafts or runs | What your organization does |
|---|---|---|
| 1. Standard-by-Standard Review (months 1-3) | Reviews your operations against each certification option and writes a findings report and remediation roadmap. | Holds the NCQA overview discussion, buys the Standards and Guidelines and the Survey Tool, and assigns an internal lead. |
| 2. Document preparation (months 3-6) | Drafts templates for credentialing policies, verification methodology for each option, monitoring logs, delegation agreements, escalation protocols, application and attestation forms, and internal audit frameworks. | Adapts the templates to your operation and starts producing the records the policies describe. |
| 3. Mock Desktop Review in Starfinch (months 6-8) | Tests a sample of practitioner files against your policies and logs, and lists the deficiencies to fix. | Corrects the deficiencies before the application. |
| 4. Application and NCQA review (months 8-11) | Drafts the application narrative and the text of any responses to NCQA requests for information. | Your named contact submits the application and responses to NCQA and handles all NCQA correspondence. |
| 5. Mock Validation Review (months 10-11) | Walks your team through a simulated review so staff and documents are ready for survey questions. | Prepares staff and confirms the evidence is complete. |
| 6. Survey and decision (months 11-12) | Supports your internal debrief on NCQA's report and drafts any follow-up material. | Your named contact receives NCQA's report and decision. |
IHS drafts. Your organization's named contact submits and communicates with NCQA.
What should we have ready for an NCQA Credentialing Certification survey?
NCQA's FAQ does not publish a list of survey findings, so this page does not rank deficiencies. IHS organizes preparation around the standards by name. Use this checklist to see where your evidence stands:
- For each certification option you are seeking, a written verification method that names the source used: the primary source, a recognized source, or a contracted agent of the primary source.
- Records showing ongoing monitoring of sanctions on the schedule your policy sets, including Medicare and Medicaid sanctions.
- Practitioner application and attestation forms, with a documented rule for who may sign, date or change them.
- Your internal quality improvement process and the records it produces.
- Policies for protecting credentialing information, including audit trail records of data changes.
- Client agreements and delegation agreements that show what you verify for each client and how reporting works.
- Proof of errors and omissions insurance within the range NCQA lists.
- A count showing you verify credentials for at least 50% of your clients' contracted practitioners.
Whether a practice meets a standard is NCQA's call. IHS maps your documents and evidence to the standard text so gaps show up before NCQA's reviewers see them.
What does NCQA Credentialing Certification cost?
The cost has three parts, and a different party sets each one.
- NCQA fees. NCQA says pricing depends on several factors and that you request full pricing through My NCQA (NCQA CVO Certification FAQ, page opened October 4, 2026). NCQA sells the Standards and Guidelines and the Survey Tool in its store, and it publishes those prices there. Verify current fees with NCQA.
- Consulting. IHS sets a fixed fee for each engagement after a free discovery session, because scope, number of sites, number of delegated contracts and gap severity change the work.
- Internal time. Plan for a credentialing program lead, credentialing specialists, IT or data staff for audit trails and monitoring, counsel for delegation agreements, and quality staff for internal audits. IHS does not replace your internal team.
For the full breakdown, see the NCQA Credentialing Certification Cost Guide.
What this is not
- IHS is not NCQA and does not grant, score or influence a certification decision. NCQA decides.
- IHS drafts the policies, templates and response text for your staff and counsel to review and approve. Your organization's named contact submits to NCQA. IHS does not submit applications.
- IHS is a consulting firm, not a law firm, and this page is not legal advice. Delegation agreement templates go to your counsel.
- IHS does not guarantee certification or a timeline.
Who leads the work at IHS?
NCQA accreditation, certification and recognition engagements are led by Maureen Plumstead. Dr. Goddard leads credentialing program design, which is building a CVO or credentialing program to meet NCQA standards. See Credentialing Program Design consulting and the IHS team.
NCQA or URAC for a CVO?
The right program is the one your clients and contracts require, so start with the delegation agreements and payer contracts you already hold or expect to sign. Ask each health plan client which accreditor's credential its agreement names. NCQA runs Credentialing Certification, which this page covers, and URAC offers CVO Accreditation. The NCQA vs URAC CVO comparison sets the two side by side.
Frequently asked questions
What is a Credentials Verification Organization (CVO)?
A CVO verifies the credentials of health care practitioners on behalf of health plans, hospitals and other contracting organizations. It confirms items such as licenses, education, board certification and malpractice history with the sources that issue them. NCQA Credentialing Certification is the NCQA program for organizations that do this work.
What are the eligibility requirements?
NCQA lists five conditions. You serve health plans, managed behavioral health organizations, physician organizations or other health care organizations. Beyond that you need six months of verification services before applying and verification work for at least 50% of contracted practitioners, plus errors and omissions insurance in the range NCQA sets and records that support a survey (NCQA CVO Certification FAQ, page opened October 4, 2026).
How long does NCQA Credentialing Certification take?
NCQA puts the usual span from submitted application to decision at 12 months and says readiness changes that figure (NCQA CVO Certification FAQ, page opened October 4, 2026). Preparation before the application comes on top of that. IHS plans that phase with you at the discovery session.
What is new in the 2025 NCQA credentialing update?
NCQA is moving Credentialing Accreditation and CVO Certification into a single credentialing program with individual Certification options, has shortened verification timeframes, and has added an 18-month Interim Survey option (NCQA news release, page opened October 4, 2026). Vendor summaries report a 90-day verification window and monthly monitoring, which IHS checks against NCQA's Standards and Guidelines.
Does NCQA certify credentialing software or credentialing organizations?
NCQA's two credentialing programs are for organizations that perform credentialing work, and NCQA's credentialing program pages do not describe certifying credentialing software. Credentialing Accreditation applies to an organization that runs the whole credentialing process, committee review included. Credentialing Certification applies to an organization that performs the verification step (NCQA Credentialing Accreditation and Certification programs, page opened October 4, 2026). NCQA's site also lists a separate HIT and Data Certification program, which this answer does not cover. If a vendor calls its product NCQA certified, ask which NCQA program and status it means. NCQA points to its Report Cards as the directory of accredited organizations (NCQA Credentialing FAQs, page opened October 4, 2026).
What do federal Medicaid managed care rules require for credentialing?
Each state must set a uniform credentialing and recredentialing policy, and each Medicaid MCO, PIHP and PAHP must follow a documented credentialing and recredentialing process for its network providers (42 CFR 438.214, Cornell LII, page opened October 3, 2026). The state policy sets the details, so read your state's policy and managed care contract.
How often must providers be recredentialed?
For Medicare Advantage plans, federal rules require recredentialing of physicians and other health care professionals at least every 3 years. The update refreshes the initial credentialing information and considers performance information such as grievances and quality results (42 CFR 422.204(b)(2), Cornell LII, page opened October 3, 2026). Medicaid managed care plans follow their state's credentialing and recredentialing policy. NCQA lists recredentialing cycle length among the areas its Credentialing Accreditation assesses, and its Standards and Guidelines document is in the NCQA Store (NCQA Credentialing FAQs, page opened October 4, 2026).
NCQA or URAC: which should I pursue?
Pursue the one your clients and payer contracts name. Review your delegation agreements first, then compare the programs in the NCQA vs URAC CVO comparison.
Who communicates with the accreditor, IHS or my organization?
Your organization. IHS drafts the documents and the text of any responses, and your organization's named contact submits them and handles all correspondence with NCQA.
Who is this not for?
It is not for an organization that only wants to build an internal credentialing program, or one that does not verify credentials for other organizations. Those projects fit Credentialing Program Design consulting. It is also not a way to get a certification decision, which only NCQA makes.
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