Credentialing in 2025: Navigating Challenges and Embracing Opportunities

As we begin 2025, the credentialing and provider data industry faces challenges and opportunities that will shape its future landscape not only this year, but for years to come. As CEO and founder of Certify, I am in a unique position to see how technological innovations and evolving customer needs together are driving toward exciting changes to come.

Challenges: The industry is undergoing significant macro changes, marking the end of an era dominated by point solutions—specialized, single-function applications designed to address specific business problems. Over the past 10–15 years, I have seen Software as a Service (SaaS) companies excelling in specific niches. However, the future belongs to platform solutions that integrate underlying infrastructure, cater to all customer needs in a unified interface, and feature a robust analytics layer. This shift is essential as the next generation of Artificial Intelligence (AI) will transform every software category and business domain, including credentialing, licensing, and provider enrollment (PE).

Opportunities: Amidst these challenges lies a unique opportunity to build a comprehensive provider data infrastructure. This infrastructure can serve as a foundation for developing platform network solutions tailored to the industry's needs. It is crucial to recognize that everything AI-related begins with data. The availability of more comprehensive and accurate data will be vital for our long-term success. This is the key factor that will empower the Certify platform to become truly intelligent.

Impact of Technology Advancements on the Credentialing Process

Advancements in technology, particularly AI and automation, will significantly impact the credentialing process. AI agents will automate most parts of the process, streamlining operations and enhancing efficiency. In the near future, I anticipate a shift from selling traditional workflows to offering workflow automation AI agents trained on our data. This evolution will redefine how we approach credentialing, making it more seamless, efficient and error free.

Beyond AI: The Next Innovation in Credentialing

Looking beyond AI, the next likely innovation for credentialing lies in the realm of compounding SaaS tools and platform solutions, including collaborative networks. By integrating various SaaS tools and platform solutions, organizations can create a cohesive ecosystem that fosters collaboration and data sharing across different stakeholders. This approach will enhance provider data accuracy, streamline credentialing processes, and ultimately lead to better patient care. Certify is positioning itself to be at the forefront of this change by continuously evolving its offerings and leveraging emerging technologies to set new industry standards.

Impact of 2025 NCQA Standards Updates on the Credentialing Industry

The 2025 updates to the National Committee for Quality Assurance (NCQA) standards will have a significant impact on the credentialing industry. These updates introduce stricter requirements, such as reduced verification timelines and increased ongoing monitoring. Payers will need to implement monthly credential expiration tracking and ensure more frequent updates to credential information. These changes aim to enhance patient safety and data integrity, reflecting NCQA's commitment to maintaining high standards throughout the provider lifecycle. As a result, credentialing organizations will need to adapt their processes and infrastructure to comply with these new guidelines, ensuring they can meet the heightened expectations for accuracy and timeliness. Only the most technologically advanced companies will be able to implement these changes with ease.

Certify’s Vision for the Future of Credentialing

Our vision for the future of provider data management lies in transforming it into a scalable, intelligent ecosystem. Certify will move beyond simply processing information to using AI to transform provider data into valuable insights. These insights will help improve network design and patient access, support compliance, and enable more efficient decision-making across operations. This integrated transformative and autonomous infrastructure will leverage AI to manage data, automate workflows, and ensure reliability with real-time validation and self-monitoring to support growth.

"The Best Way to Predict the Future is to Create It." – Peter Drucker

I am excited about how Certify is shaping the future of the credentialing industry. If you’re interested in seeing how our solutions can benefit your organization, I invite you to book a free demo with us today. Experience firsthand how Certify can transform your credentialing processes and help you stay ahead in this evolving landscape.