2026 Credentialing and Provider Network Standards and Guidelines

What the authority record establishes

NCQA's credentialing and provider network standards support defined accreditation and certification programs. Public summaries do not reproduce the licensed standards or establish an organization's current status.

Applies according to the selected NCQA program, survey cycle, scope, contract, and licensing terms; it is not a general statute

The exact official title, issuing body, jurisdiction, version or application record, and linked source define the scope of this page. Readers should not transfer the authority's status to a commercial product or infer transaction-, patient-, system-, site-, or organization-specific applicability from this summary.

Why it matters to this market

Buyers must identify the exact NCQA program, option, organization, scope, survey period, and delegated responsibilities before using accreditation language or mapping a product workflow.

Affected operating stages

• Credentialing
• Recredentialing
• Primary-Source Verification
• Delegation Oversight
• Provider Network Operations
• Accreditation Evidence

Capabilities to examine

Practitioner Application And Attestations

Ask how the system or service identifies the controlling source and version, applies customer-specific interpretation, handles exceptions, preserves human judgment, and retains evidence for practitioner application and attestations.

Primary Source Verification

Ask how the system or service identifies the controlling source and version, applies customer-specific interpretation, handles exceptions, preserves human judgment, and retains evidence for primary source verification.

Credentialing And Recredentialing Workflow

Ask how the system or service identifies the controlling source and version, applies customer-specific interpretation, handles exceptions, preserves human judgment, and retains evidence for credentialing and recredentialing workflow.

Delegated Credentialing And Oversight

Ask how the system or service identifies the controlling source and version, applies customer-specific interpretation, handles exceptions, preserves human judgment, and retains evidence for delegated credentialing and oversight.

Credentials Verification Organization Services

Ask how the system or service identifies the controlling source and version, applies customer-specific interpretation, handles exceptions, preserves human judgment, and retains evidence for credentials verification organization services.

Expirables And Renewal Monitoring

Ask how the system or service identifies the controlling source and version, applies customer-specific interpretation, handles exceptions, preserves human judgment, and retains evidence for expirables and renewal monitoring.

Sanctions, Exclusions, And Adverse-Action Monitoring

Ask how the system or service identifies the controlling source and version, applies customer-specific interpretation, handles exceptions, preserves human judgment, and retains evidence for sanctions, exclusions, and adverse-action monitoring.

Audit Trail, Source Provenance, And Committee Evidence

Ask how the system or service identifies the controlling source and version, applies customer-specific interpretation, handles exceptions, preserves human judgment, and retains evidence for audit trail, source provenance, and committee evidence.

Analytics, Turnaround, And Operational Reporting

Ask how the system or service identifies the controlling source and version, applies customer-specific interpretation, handles exceptions, preserves human judgment, and retains evidence for analytics, turnaround, and operational reporting.

Affected buyer audiences

• health plans
• credentials verification organizations
• delegated credentialing entities
• provider network teams
• accreditation and compliance leaders

Implementation questions

• Which entities, products, populations, transactions, systems, sites, or jurisdictions are actually within scope?
• What is binding, what is guidance, and what is a technical or consensus standard?
• Which publication, adoption, effective, application, transition, and enforcement dates differ?
• Who owns legal, clinical, quality, regulatory, policy, or operational interpretation?
• How will a source revision affect open work and historical decisions?

Interpretation boundary

Only NCQA can establish current accreditation or certification. The publication does not reproduce licensed criteria or claim that software is NCQA accredited or conformant.