Five Pillars for a Smarter, Stronger Credentialing Year
As the healthcare landscape continues to evolve at an unprecedented speed, Medical Services Professionals (MSPs) find themselves at the intersection of compliance, technology, and provider experience. The role of the MSP has expanded from a historically administrative function to a strategic backbone of provider readiness and patient safety with data, automation, and proactive oversight now central to success.
Heading into 2026, MSPs face both unforeseen challenges and exciting opportunities. From emerging automation and generative AI tools to new payer and accreditation expectations, this year demands a proactive, informed, and highly adaptable approach.
Whether you’re managing a credentialing team, optimizing workflows, facilitating provider-payer operations, or preparing for compliance audits, here are five key pillars every MSP should prioritize to stay ahead in 2026 with accuracy and context grounded in the latest industry updates.
Pillar 1: Regulatory Shifts and Compliance Trends
Accreditation Updates (Joint Commission)
The Joint Commission has launched Accreditation 360: The New Standard—a transformative overhaul of its accreditation framework for hospitals and critical access hospitals. This approach:
- Simplifies and reorganizes requirements into measurable, performance-focused goals.
- Reduces the number of standards and consolidates requirements to better align with CMS Conditions of Participation (CoPs). Joint Commission
- Introduces a Continuous Engagement Model option for ongoing operational support and perpetual survey readiness.
- Offers public, searchable access to standards online.
These changes do not eliminate compliance expectations; rather, they streamline and clarify them with more explicit links to regulatory requirements and outcome-focused goals. Joint Commission
Note: There is no public indication that Accreditation 360 introduces AI as a formal requirement, though many organizations are using AI-powered tools to support readiness.
NCQA Credentialing Standards
The NCQA 2025 updates to credentialing standards include:
- Monthly monitoring of provider license expiration dates as a formal requirement (continuous tracking).
- Expanded ongoing monitoring expectations (e.g., sanctions, exclusions, SAM.gov checks) in many credentialing environments.
- Revisions to verification timeframes and consolidation of credentialing processes in some NCQA programs. NCQA
NCQA has also released draft 2026 standards, effective July 1, 2026 for surveys. NCQA
What does this mean for MSPs?
Compliance will increasingly require continuous readiness rather than annual preparation. Monthly monitoring, documentation integrity, and real-time data visibility are now the norm—not optional.
Pillar 2: Technology, Automation, and AI in Credentialing
Technology continues to redefine the way MSPs perform their roles, and 2026 will be no exception. What used to be manual and paper-heavy processes are now increasingly digital, automated, and AI-enhanced.
AI-Augmented Credentialing Platforms
Expect to see more credentialing software vendors incorporating:
- Machine-assisted verification flags that surface red flags automatically.
- Predictive alerts for upcoming expirations or compliance gaps.
- Dashboard analytics that offer AI-generated insights into bottlenecks and trends.
While not required by regulators, AI augmentation is rapidly becoming a competitive standard for credentialing platforms notably helping organizations stay audit-ready at scale.
Key Technical Capabilities to Prioritize
- Automated primary source verification
- Real-time license & sanction monitoring
- Customizable workflow dashboards
- Enhanced onboarding automation
- Connectivity with EMRs and payer portals
These systems reduce human error and provide MSPs with actionable insights that empower faster, more confident decisions.
Data Security Imperatives
With credentialing data containing sensitive provider information, MSPs must also ensure:
- HIPAA-compliant workflows
- Encrypted storage and secure access controls
- Multi-factor authentication
- Regular cyber risk assessments
Balancing the benefits of automation with robust cybersecurity governance will be non-negotiable in 2026.
Pillar 3: Workforce Transformation
The MSP role is shifting into a strategic operations role that requires advanced skills and adaptability.
Skills MSPs Should Develop
- Digital literacy with credentialing technologies
- Data interpretation and analytics
- AI oversight and validation
- Cross-functional collaboration with compliance, IT, and operations
Training and Professional Growth
Upskilling through formal credentialing education, certification programs (e.g., NAMSS certifications, MD-Staff Certifications), and role-specific training will differentiate high-performing teams.
Remote and hybrid work models also require strong virtual communication practices, workflow clarity, and data security discipline across distributed teams.
Pillar 4: Prioritizing the Provider Experience
Removing friction from credentialing helps reduce burnout and enhances provider satisfaction.
Strategies for a Better Provider Experience
- Simplify application and verification workflows where possible.
- Use automation to reduce redundant manual tasks.
- Provide clear timelines and regular status updates.
- Offer accessible support channels throughout onboarding.
Meaningful Metrics to Track
Focus on impactful operational metrics, such as:
- Time-to-Credential: Average days from submission to completion.
- First-Time Approval Rates: Indicates clarity of process and documentation quality.
- Provider Satisfaction Scores: Direct feedback on experience and pain points.
Tracking the right metrics enables continuous improvement and demonstrates value.
Pillar 5: Strategic Planning and Future Proofing
Goal Setting & Roadmap Development
Create a clear, actionable roadmap that aligns with organizational priorities and evolving regulatory expectations. Include:
- Quarterly goals grounded in operational realities
- Cross-departmental collaboration points
- Risk mitigation planning for major compliance shifts
Leverage Data for Predictive Insights
Use analytics to:
- Identify bottlenecks and forecast demand
- Predict credentialing needs based on growth projections
- Drive evidence-based process improvements
Preparing for Scalability
Ensure your systems and teams can scale with organizational complexity:
- Choose scalable, flexible software platforms
- Develop workforce plans for peak workloads
- Build adaptability for mergers, acquisitions, or service expansion
Conclusion
As we step into 2026, these five pillars form the foundation for MSP success in an increasingly complex healthcare ecosystem. Modern credentialing requires:
- Continued regulatory awareness
- Strategic use of automation and AI
- Cutting-edge technology adoption
- Provider-centric operations
- Data-driven planning
Emerging tools like AI-assisted credentialing insights and real-time monitoring systems offer a competitive advantage in both compliance and operational efficiency.
A Final Note of Appreciation
Thank you to every MSP working behind the scenes to ensure provider readiness, patient safety, and quality care delivery. Your expertise, resilience, and commitment keep the healthcare system functioning and evolving for the better.
Here’s to making 2026 your most informed, efficient, and successful year yet!
And as always, MD-Staff is here to support you every step of the way—helping streamline workflows, strengthen compliance, and empower MSPs to do their best work with confidence.
