NCQA credentialing standards checklist
Key takeaways
- Start with written policies that match what staff actually do.
- Every verification should show the source, the date and who verified, within the allowed time limit.
- Check sanctions and license actions between cycles as well as at credentialing.
- If you delegate verification, keep a written agreement and audit the other organization's work.
- Buy NCQA's current standards for the exact requirements.
Program and policies checklist
- Written credentialing and recredentialing policies exist and are reviewed at least once a year.
- Policies describe who is eligible, what is verified and how decisions are made.
- Policies match what staff actually do.
Credentialing committee checklist
- A committee with clinical members reviews files and makes or recommends decisions.
- Minutes show each decision and any concerns.
- Conflict of interest is handled and documented.
- Files with issues receive extra review.
Primary source verification checklist
- Licenses are verified from the issuing board or an accepted source.
- Education and training are verified as required.
- Board certification is verified where relevant.
- Work history and malpractice history are reviewed.
- Verification dates fall within the allowed time limit before the decision.
- Documents show the source, date and who verified.
Sanctions and ongoing monitoring checklist
- Exclusion lists and sanctions are checked at credentialing and between cycles.
- License actions and complaints are tracked.
- Corrective action is documented.
Applications and attestations checklist
- Applicants complete a signed application with attestation about their history.
- Missing or inconsistent information is resolved before approval.
Recredentialing checklist
- Clinicians are recredentialed on the required cycle.
- Performance and complaint information is considered.
File quality checklist
- Files are complete, organized and accessible to auditors.
- Reviewers can see each verification and its date at a glance.
Payers check the same file quality before they delegate. Our guide to delegated credentialing for behavioral health groups explains what they look for.
Delegation oversight checklist
- If you delegate verification to another organization, you have a written agreement.
- You audit their work on a regular schedule.
- You keep ultimate responsibility.
Privacy and security checklist
- Credentialing files are kept confidential and secured.
- Access is limited and logged.
Frequently asked questions
How many files should I audit against NCQA credentialing standards?
Audit a meaningful sample, including newly hired and recredentialed clinicians. Check each file for complete documents, verification dates within the allowed time limit, and the source, date and verifier for every item. Payers audit a sample of files before they delegate, so your own sample should hold up the same way.
Should I wait for a survey to fix findings?
No. Fix and document gaps early. Common findings include missing or expired documents, verification dates outside the allowed window, committee minutes that skip decisions and no evidence of ongoing monitoring. Fixing them before anyone else sees your files gives you time to correct the process behind them.
Is this checklist a substitute for NCQA's standards?
No. It is a readiness aid in our own words. Buy and follow NCQA's current standards for the official requirements.
How Delegate helps
Delegate prepares behavioral health groups for NCQA Credentialing Accreditation. Book a gap assessment.
Related guides
For the bigger picture on earning accreditation, read NCQA Credentialing Accreditation explained. To connect standards work to payer agreements, see delegated credentialing for behavioral health groups.
Sources and check dates
- NCQA Credentialing standards and publications: https://www.ncqa.org/ (purchase and confirm the current standard set directly)
- Content last checked: October 9, 2026. Standard elements change; re-check before a survey.
Delegate is an independent consultancy and is not affiliated with NCQA.