Monthly Monitoring Madness
Why NCQA’s Monthly Checks Are Breaking Credentialing Teams in 2026
Remember when credentialing verification was a twice-a-year task? Those days are gone. NCQA now requires monthly monitoring of licenses and sanctions, and in 2026, enforcement is strict. For credentialing teams, this means more work, tighter timelines, and higher compliance risk.
What Changed?
- NCQA shortened verification timelines from 180 to 120 days in 2025
- Monthly monitoring became mandatory for licenses, sanctions, and exclusions
- Payors adopted these standards aggressively, making them non-negotiable
Why It Matters?
Failing to monitor monthly can lead to:
- Network Termination
- Compliance Penalties
- Delayed Claims and Enrollment
How to Survive
- Automate monitoring with credentialing software
- Utilize experts like NIHC for real-time compliance checks
- Schedule monthly audits and document everything
Provider Directory Accuracy Under Fire
The Silent Revenue Killer: Directory Errors and Compliance Penalties in 2026
Provider directories aren’t just a marketing tool—they’re a compliance requirement. CMS audits reveal error rates as high as 45%, and penalties for inaccuracies are steep. In 2026, payers demand real-time updates, and practices that fail to comply risk losing revenue.
The Problem
- Manual updates fail to keep pace with regulatory demands
- Telehealth indicators and accessibility details often go missing
- Payers require updates every 90 days—or sooner
Impact
- Claim denials due to mismatched data
- Compliance violations under the No Surprises Act
- Lost referrals and patient trust
Solution
- Centralize data management
- Automate directory updates
- Utilize experts (like NIHC) for accuracy and compliance
Automation Isn’t Enough
Credentialing Bottlenecks in the Age of AI: Why Humans Still Matter in 2026
AI promised to revolutionize credentialing—but in 2026, bottlenecks persist. Why? Because automation can’t handle payer-specific quirks, regulatory nuances, or complex contracting negotiations. Technology helps, but human expertise is still the secret weapon.
Why Automation Falls Short
- Payer portals have unique workflows that AI can’t fully predict
- Regulatory changes require interpretation, not just data entry
- Exceptions and escalations need human judgment
The Hybrid Model
- Combine automation for speed with expert oversight for accuracy
- Leverage experts (like NIHC), where technology meets credentialing expertise