Want to join the Cigna Healthcare network? But don’t know the standard credentialing criteria? Let us simplify Cigna’s credentialing process! If you are a medical, dental, or behavioral healthcare provider, you might already know about this global health service company. With a network of more than 2 million providers, clinics, and facilities, Cigna is a reliable health partner.
It provides numerous health benefits, including insurance plans, to individuals, families, and employers, serving over 15 million medical customers. Hence, joining its network means receiving more patients and more reimbursement opportunities.
Unfortunately, Cigna’s provider credentialing process is quite complicated and can leave you waiting for months. But that’s where we come in. Read our step-by-step guide to save yourself from major headaches.
A Step-by-Step Guide to Cigna Credentialing Application
Let’s discuss Cigna’s credentialing process step-by-step:
Step 1: Review & Verify Eligibility Criteria
This is the most important pre-application step. Therefore, make sure you meet all eligibility requirements before applying to become an approved Cigna provider. You can verify this by visiting Cigna’s website or by calling 1 (800) 882-4462.
During the call, you will be asked to select a credentialing option and provide some basic information. Then the representative will let you know whether you meet the basic criteria to begin the application process. However, note that this number is for medical credentialing only.
If you are seeking to join Cigna’s dental network, call 1 (800) 244-6224. You may also email at DentistEnrollment@cignahealthcare.com with your name, office name, office address, and CAQH ID.
Step 2: Verify Network Participation (Behavioral Healthcare Providers Only)
The pre-application step for the Evernorth® Behavioral Health (Evernorth) provider network is quite different. Before starting the application process, review the provider directory to confirm you are not already a part of this network. Only proceed to the next step if you are not listed in the directory. Otherwise, don’t submit a Provider Information Form.
Step 3: Gather Required Documentation or Update Your CAQH Profile
Once eligibility is confirmed, Cigna will send you an application packet containing information about the required documentation, forms, fees, and other information. The next step is to gather and prepare these materials, which may include:
- Current licenses
- Board certifications
- Malpractice insurance certificate
- Other practice-specific documents
Another important reminder? These requirements may differ for dentists. However, don’t worry, as we will cover those details in the next section. If you already have a CAQH profile, review it carefully and update it as needed.
Step 4: Submit Your Application
For Medical Network
There are two ways to submit your Cigna credentialing application:
1. Online Submission
If you have a Council on Affordable Quality Healthcare (CAQH) or the One Healthport/Medversant profile, we recommend using it to provide all the necessary details. Here is how you can do that:
- Make sure your CAQH profile status is either “Initial Profile Complete” or “Re-attestation.”
- Give Cigna the essential permissions to access your profile electronically.
What about those with One Healthport/Medversant? The process is quite similar. Just make sure that your profile has been attested within the last 100 days.
2. Paper Submission.
The second option is quite straightforward! All you have to do is:
- Complete all applicable fields in the Cigna credentialing application.
- Print and mail it to Cigna along with the required attachments.
For Dental Network
The application submission process for joining Cigna’s dental network is the same as the medical network. In short, you must submit your credentials electronically through one of the following:
- CAQH Universal Credentialing DataSource
- One Healthport/Medversant
- Cigna’s e-onboarding tool
Moreover, just like the medical network, you can also submit a state application for joining Cigna’s dental network.
For Behavioral Health Network
On the other hand, the submission process for Cigna’s behavioral health network, officially known as the Evernorth Behavioral Health network, is quite different. Whether you are an individual provider or a new behavioral healthcare provider affiliated with contracted clinics and facilities, you must complete and submit the Evernorth Behavioral Health Provider Information Form.
Step 5: Follow-Up & Wait for the Approval
After receiving your application, Cigna will begin the review process. This typically takes 45 to 60 days (for medical healthcare providers) and up to 90 days for behavioral health providers. The company will send various emails during this time to keep you updated. They can also request additional information, so always remain vigilant and check your inbox frequently.
If the process is taking longer than expected, medical providers can check their Cigna credentialing application status by emailing PSSCentral@Cigna.com or calling 1 (800) 882-4462. Behavioral health providers can also call the same number. However, for email inquiries, they should use BehavioralProviderRecruitment@evernorth.com.
Cigna Provider Credentialing Requirements
Cigna has clarified the standard criteria for becoming an in-network medical, dental, or behavioral health provider on its website. So, without further ado, let’s get into those details:
Cigna Credentialing Requirements for Joining the Medical Network
Regardless of your application method, Cigna requires you to apply with the following information:
| Key Requirements | Description |
|---|---|
| Valid License (medical or professional) | You must have an active and unrestricted medical license from an appropriate licensing agency. |
| Drug Enforcement Agency (DEA) Registration | You must also have a valid and unrestricted DEA certificate, one for each practicing state. |
| Controlled Dangerous Substances (CDS) Certificate | You must also submit a valid and unrestricted CDS certificate, if required by the state. |
| Board Certification | Also include your board certification status by the American Board of Medical Specialties or the American Osteopathic Association. |
| Professional Education and Training Verification | Provide official documentation of your education, residency, and any additional training essential to the network you are applying for. |
| Work History | Provide a comprehensive 5-year work history. You must explain an employment gap of more than 6 months. |
| Prior Penalties | You must disclose prior sanctions (if you have received any) by applicable regulatory bodies, including CMS. |
| Malpractice Claims History | Include details about your professional negligence (if there is any) |
| Adequate Malpractice Insurance | Provide proof of current malpractice insurance coverage, meeting Cigna’s minimum requirements ($1,000,000 per occurrence and $3,000,000 in the aggregate). |
| Cigna Healthcare-Participating Hospital Clinical Privileges | You must have a good professional record to maintain these privileges (admitting and treating patients at an in-network hospital) |
Cigna Credentialing Requirements for Joining the Behavioral Health Network
The Evernorth Behavioral Health network has different criteria for individual providers, clinics, and facilities. But since we are specifically talking about Cigna provider credentialing, here is a breakdown of key requirements for behavioral health providers:
| Key Requirements | Description |
|---|---|
| Valid License | You must hold a valid license to practice independently (without any supervision) in the state where services are provided. |
| Professional Liability Insurance | Provide proof of your professional liability insurance, meeting Evernorth’s minimum requirements: – $1 million/ $3 million for physicians and psychiatric nurses with prospective authority.- $1 million/ $1 million for all other providers. |
| For Texas, the minimum recommended amount for professional liability coverage is $200,000 per occurrence and $500,000 per aggregate. | |
| NPI number | You must also provide a valid National Provider Identifier (NPI) number. |
| CAQH Profile Requirements | If you are working in an outpatient private practice setting, you must have a CAQH profile. |
| You must include the CAQH identification number on the Evernorth Behavioral Provider Information Form | |
| CAQH Documentation Requirements | – You must attest your information every 120 days.- Give your profile access to Evernorth.- Upload a recent W-9 (must match TIN used on application form).- Also upload current state license(s) for all service locations (valid for at least 2 more months).- All prescribing providers must upload a current DEA on their profile for all service locations (must be valid for 2 more months).- List the highest level of education.- Upload 5 years of consecutive work history, with no unemployment gaps of more than 6 months. |
Note: if you are a behavioral health provider with federal tort coverage, you do not have to meet Evernorth’s minimum professional liability insurance thresholds. Just provide a copy of the federal tort letter or attestation from the insurance payer.
Cigna Credentialing Requirements for Joining the Dental Health Network
To join Cigna’s dental network, you must provide the following information:
| Key Requirements | Description |
|---|---|
| Valid Dental License | Dentists must have an active and unrestricted dental license. |
| W-9 Form | You must also upload a complete and signed IRS W-9 form matching your Tax Identification Number (TIN). |
| Valid DEA registration | If you are not an orthodontist, you must also provide a valid DEA certificate. |
| Specialty Training Certificate | Provide proof of your advanced training (if there is any). |
| Professional Liability Insurance | Submit a copy of your current malpractice insurance’s declaration page. |
Challenges in Getting Credentialed with Cigna
Many providers want to expand their patient base and receive proper reimbursement for their services. That’s why they apply for the Cigna healthcare credentialing and enrollment process. Unfortunately, this procedure is quite challenging and often results in approval delays and even rejections.
So, what are the most common Cigna credentialing challenges? Let’s find out!
Credentialing Delays Due to Outdated CAQH Profile
This is the most common challenge when credentialing with Cigna! Most providers have outdated CAQH profiles. The common reason? It is not their main priority! As a result, they face enrollment issues when payers, such as Cigna, notice discrepancies during verification, such as expired licenses, missing work history, or incorrect contact details.
This ultimately leads to rejected applications, insurance claim denials, and delayed enrollment.
Slow Verification Due to Missing or Incorrect Documentation
As mentioned above, Cigna has specific requirements for enrolling in its medical, dental, and behavioral health networks. You must adhere to these standard criteria and upload the essential documents, including valid license(s), work history, DEA registration, and professional liability insurance.
Even minor mistakes, such as an expired DEA certification or missing information about prior penalties, can significantly slow down the verification process. Note that verification delays may also occur on your end, especially if the references you provided are unresponsive.
Lack of Clarity Due to Miscommunication
Cigna is very transparent about its credentialing requirements and contact details. In simple terms, it has dedicated email addresses for different providers. However, most healthcare providers often struggle to reach the correct Cigna credentialing representatives due to communication confusion.
This leads to communication gaps, making it difficult for providers to track their Cigna credentialing application status.
Best Practices for Cigna Insurance Credentialing
Want to overcome these challenges? Follow these best practices for a smooth Cigna provider credentialing:
Comply with Cigna’s Requirements
This is the most important step! Carefully review Cigna’s credentialing criteria, including the minimum threshold for malpractice insurance coverage, before initiating provider enrollment. Remember that Cigna has different benchmarks for medical and behavioral health providers, depending on their location.
For example, we have already discussed the minimum recommended amount of professional liability coverage for Texas providers in credentialing requirements. For behavioral health providers in Florida, the minimum required coverage limit is $100,000 per occurrence and $300,000 aggregate.
Organize Everything in Advance
It is common knowledge that credentialing is a time-consuming process. However, you can save weeks and even months of frustration if you are rightly prepared. One key tip? Organize everything in advance! This includes gathering all the essential documents, maintaining an updated CAQH profile, and attesting it every 120 days.
Take it a step further by proactively preparing written explanations for any malpractice claims in your work history.
Promptly Respond to Additional Requests
Keep this possibility in mind that Cigna may request additional information at any stage of the enrollment process. To avoid any delays, keep an eye on your inbox and quickly respond to Cigna’s request for additional documents.
Track Application Status & Follow-Up
Make sure your Cigna credentialing application is right on track. As mentioned earlier, Cigna’s provider credentialing and enrollment process can take anywhere from 45 to 90 days, depending on the type of network you are interested in. Remember that provider credentialing doesn’t end at application submission. You must take regular follow-ups with Cigna to avoid delays and rejections.
Keep an Eye on Recredentialing Reminders
Cigna requires recredentialing every three years in most states. The payer will send an email when your renewal date is near, asking you to confirm that your CAQH profile is up to date. To avoid disruptions in your network status, be sure to track these key dates and update all information ahead of time.
Outsource Cigna Credentialing to a Professional
This is the easiest way to become an in-network provider. Instead of dealing with complicated network enrollment requirements on your own, simply hand it over to one of the leading medical billing companies.
Partner with MediBillMD for a Smoother Credentialing Process
Looking for an outsourcing partner? You can choose our insurance credentialing services for a smoother enrollment process. At MediBillMD, we verify everything beforehand and keep up with payers’ changing requirements. Our team perfectly understands that Cigna has specific requirements for each of its networks (dental, medical, and behavioral health).
Therefore, we submit network-specific applications, helping you succeed the first time. So, there are no second takes with MediBillMD! We handle every step of Cigna’s credentialing process, from collecting relevant documentation and maintaining your CAQH profile to submitting applications on time and taking regular follow-ups. You can rely on our expertise to secure a spot on your preferred panel.
