2025 Credentialing Navigator: Charting the course for CMS & NCQA Changes
Hello everyone and welcome back. Today, we’re discussing the upcoming changes for CMS and NCQA in 2025. Thanks for joining us, Yesenia Servin.
I’m excited to be here. While today might feel like a bit of a laundry list, it’s going to be informative.
First, there are big changes for Medicare Advantage plans in 2025. Some plans will end this year, and new ones are entering the market. Make sure to check which plans are terming and which new ones require enrollment for your providers or organization.
We’ve also got a useful tool to track these changes. Follow us on LinkedIn for the link and updates on these plans.
Regarding telehealth, CMS is reverting back to pre-public healthcare emergency guidelines. This might be concerning due to the ease of access telehealth provides. Stay updated by signing up for CMS newsletters and following our LinkedIn.
For provider participation, remember to check and update your providers’ PAR status before the end of December. Not having it can result in missed reimbursements.
A key question lately concerns NCQA changes and CAQH compliance, specifically regarding demographic information. CAQH is working to meet the 2025 NCQA requirements, so stay tuned for updates.
For Medicare enrollment, be aware of upcoming 855A form changes such as reporting requirements for hospice and SNF directors, and the introduction of a new Rural Emergency Hospital provider type. This could lead to potential reimbursement increases.
There have also been updates with 855B forms, allowing group apps to manage reassignments directly, which simplifies the process. Additionally, the Medicare submittal process now accommodates Medicaid requirements without risk of disenrollment.
Lastly, note that Marriage and Family Therapists and Mental Health Counselors can now participate as fully licensed Medicare providers, expanding services for Medicare participants.
Thank you for joining us. Don’t forget to check our LinkedIn page for links and updates.
Thank you, Yesenia. It was a pleasure. We’ll post all the information on our LinkedIn page and look forward to our next session after the new year. Bye, Yesenia.
Thank you, everyone. Bye.
Alesha Pearson
Since 2003, Alesha has specialized in healthcare credentialing software, excelling in training, implementation, and project management. She builds strong customer relationships, provides strategic feedback, and consistently achieves high customer satisfaction scores (CSAT) of 85% or higher. Her customer-first approach, grounded in honesty and transparency, ensures lasting partnerships.
