A Guide to Provider Credentialing with Cigna

Cigna’s credentialing process is designed to verify the qualifications, background, and professional competency of healthcare providers. This thorough vetting ensures that Cigna members have access to qualified healthcare professionals who meet high standards of patient care.

Purpose of Credentialing

• Ensure patient safety and quality care delivery
• Verify provider qualifications and competency
• Meet regulatory requirements and accreditation standards
• Maintain the integrity of Cigna’s provider network
  

Initial Application Steps

CAQH ProView Registration

• Cigna primarily uses CAQH ProView or CAQH Provider Data Portal for credentialing
• Providers must maintain an up-to-date CAQH profile
• Regular attestation is required (typically quarterly)

Required Documentation

• Current state medical license(s)
• DEA certification (if applicable)
• Professional liability insurance
• Board certifications
• Curriculum vitae
• Educational background verification
• Clinical privileges at participating hospitals
• Work history (minimum of five years)
• Professional references

Application Timeline

The typical credentialing process with Cigna takes 60-90 days, though this can vary based on several factors:

• Completeness and accuracy of the application
• Verification of primary sources
• Response time from references and previous employers
• Current credentialing volume at Cigna
  

Participation Options

Cigna offers different network participation options:

Commercial Networks

• Traditional PPO networks
• LocalPlus® networks
• Behavioral health networks

Medicare Advantage Networks

Collaborative Care Programs

Each option may have specific additional requirements or considerations.

Quality Standards

Cigna emphasizes quality care delivery through:

Quality Metrics Monitoring

• Patient outcomes tracking
• Adherence to clinical guidelines
• Patient satisfaction scores

Cost Efficiency Standards

• Appropriate resource utilization
• Adherence to evidence-based practices
  

Preparation is Key

Before initiating the credentialing process:

• Ensure all licenses and certifications are current
• Update your CAQH ProView profile completely
• Gather all required documentation
• Verify malpractice insurance meets Cigna’s requirements

Accuracy in Documentation

Maintain precise records:

• Double-check all dates and information
• Explain any gaps in work history
• Provide detailed explanations for any disciplinary actions or malpractice claims

Follow-Up Protocol

Stay engaged in the process:

• Keep a log of all submissions and communications
• Follow up every 2-3 weeks on application status
• Respond promptly to any requests for additional information
  

Challenge 1: Incomplete CAQH Profile

Solution:

• Set regular reminders to update CAQH information
• Use CAQH’s completeness meter to ensure all sections are filled
• Save a copy of your CAQH profile for reference

Challenge 2: Verification Delays

Solution:

• Inform previous employers and references about potential verification requests
• Provide multiple contact methods for each reference
• Consider using a credentialing service to expedite the process

Challenge 3: Network Adequacy

Solution:

• Research Cigna’s network needs in your area
• Highlight unique services or specialties you offer
• Consider multiple practice locations if appropriate
  

Cigna requires recredentialing every three years.

Key aspects include:

Recredentialing Timeline

• Typically begins 6 months before the three-year mark
• Providers are notified via mail or email

Updated Information

• Current licenses and certifications
• Any changes in practice location or services
• Updated malpractice history
• Continuing education documentation

Performance Review

• Quality metrics evaluation
• Patient satisfaction scores
• Adherence to Cigna policies
• Claims history review
  

Digital Tools

Cigna utilizes various technological solutions:

Provider Portal

• Application status tracking
• Document submission
• Updates and notifications

Electronic Verification Systems

• Automated license verification
• Real-time updates for certain credentials

Tips for Using Cigna’s Digital Platforms

• Bookmark important portal pages
• Keep login credentials secure but accessible
• Familiarize yourself with the portal’s features
• Use electronic document submission when possible
  

Credentialing Costs

• Application fees (if applicable)
• Time investment in documentation
• Potential need for credentialing assistance

Post-Credentialing Financial Impact

• Understanding Cigna’s fee schedules
• Billing procedures and requirements
• Claims submission processes
  

Regulatory Compliance

Providers must adhere to:

1. State-specific requirements
2. Federal regulations
3. Cigna’s compliance programs

Documentation Requirements

• Maintain accurate and complete records
• Regular updates of practice information
• Adherence to Cigna’s policies and procedures
  

Primary Care Physicians

• Patient panel requirements
• Quality metric expectations
• After-hours coverage documentation

Specialists

• Referral processes
• Subspecialty certification requirements
• Procedure volume documentation

Behavioral Health Providers

• Specific licensure requirements
• Session length and frequency guidelines
• Telehealth credentials if applicable
  

Ongoing Compliance

• Regular review of Cigna’s provider manuals
• Participation in required training
• Adherence to utilization management guidelines

Quality Performance

• Monitoring of quality metrics
• Participation in quality improvement initiatives
• Regular review of patient satisfaction data

Communication

• Keeping contact information current
• Prompt reporting of any practice changes
• Regular interaction with provider representatives