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Commercial payers update their credentialing requirements regularly, and 2025 has brought meaningful changes across several major payers and industry-wide CAQH policies. Here is what providers and practice managers need to know.

CAQH ProView Updates for 2026

CAQH announced expanded data fields in ProView effective January 2025: mandatory disclosure of all telemedicine services offered with state-by-state breakdown, expanded sanctions history covering all 50 states, digital identity verification (a one-time process where CAQH verifies your identity against government ID databases), and updated attestation monitoring where CAQH may request interim attestation if significant profile changes are detected.

UnitedHealthcare Updates

UHC updated its network participation requirements in early 2025: enhanced review for behavioral health providers applying for UHC commercial networks (expect additional documentation requests around clinical training), CAQH profile attestation now required within 90 days of the application date down from 120, and new malpractice insurance minimum requirements for certain surgical specialties.

Aetna Provider Data Requirements

Aetna strengthened provider data accuracy requirements in 2026 as part of CMS push to improve provider directory accuracy. Providers must update office location and accepting-new-patients status within 30 days of any change (previously 90 days). Aetna will conduct quarterly automated validation checks against NPPES data. Discrepancies generate a notification requiring response within 30 days or risk provider directory suspension.

Anthem and BCBS Regional Changes

Humana Medicare Advantage Update

Humana now requires providers applying to Humana MA networks to complete brief quality reporting training as part of credentialing. This is an online module, typically 60 to 90 minutes, that must be completed before your application is fully processed.

Staying Current With Payer Requirements Is Our Job

We monitor payer requirement changes across all major commercial carriers continuously. When you work with us, your applications are built to the current requirements, not last year's template.

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JR

James Reyes, CPC

Senior Credentialing Specialist with 15+ years of experience navigating state Medicaid portals, Medicare PECOS, and commercial payer panels. Certified Professional Coder (CPC) dedicated to eliminating revenue cycle bottlenecks.