Cigna Credentialing Standards Update

Cigna's Credentialing Standards: What Providers Need to Know in October 2025 

Cigna Healthcare's credentialing program implements systematic processes that ensure provider quality and patient safety. 

The Three-Year Recredentialing Cycle 

In most states, providers in Cigna's network undergo recredentialing assessments every three years. This industry-standard cycle balances thoroughness with administrative efficiency. The recredentialing process requires providers to meet the same criteria as during initial credentialing, ensuring that qualifications, licensure, and professional standing remain current throughout network participation. 

During recredentialing, Cigna verifies key elements: valid professional licensure, current liability insurance, DEA registration (when applicable for prescribing controlled substances), education and training credentials, complete work history, and comprehensive sanction checks. Timely completion of recredentialing requests helps ensure uninterrupted network participation. 

Continuous Monitoring Between Cycles 

Cigna conducts ongoing monitoring of providers between recredentialing cycles. This surveillance includes checking regulatory databases, reviewing complaints, monitoring for sanctions, and examining public reports about provider quality and safety. 

Regulatory Database Monitoring: Between recredentialing cycles, Cigna monitors state medical board databases, federal exclusion lists, and sanction databases. This helps identify license changes, restrictions, or disciplinary actions as they occur rather than waiting for the next formal recredentialing cycle. 

Complaints and Quality Oversight: Patient complaints, quality concerns, and member grievances are reviewed through established processes. Significant issues may be referred to credentialing committees for evaluation. 

Sanctions and Disciplinary Actions: Sanctions imposed by licensing boards, Medicare/Medicaid programs, or other regulatory bodies are monitored and may trigger review of network participation status. 

Public Information: Publicly available information about provider quality, including hospital disciplinary actions and malpractice judgments, is monitored as part of ongoing oversight. 

Core Credentialing Requirements 

Cigna's credentialing criteria include verification of: 

• Valid, unrestricted professional license in states where the provider practices 
• Professional liability insurance meeting specified coverage requirements 
• DEA registration for providers prescribing controlled substances 
• Education and training, including medical school, residency, fellowship, and board certification status 
• Work history documentation 
• Sanction checks across relevant databases to identify disciplinary history, malpractice settlements, or program exclusions 

What Providers Should Know 

To maintain network participation with Cigna: 

Keep credentials current: Maintain active licenses, DEA registrations (if applicable), and liability insurance without lapses. Expired credentials can affect network participation status. 

Complete recredentialing requests: Respond to recredentialing requests within the timeframes specified. Behavioral health providers should note that Cigna Behavioral Health has specific recredentialing timelines and notification requirements. 

Report changes: Providers are expected to notify Cigna of significant changes, including practice location changes, malpractice claims, or disciplinary actions. 

Maintain quality standards: Address any quality concerns or complaints through appropriate channels. Ongoing monitoring processes help identify issues that may require attention. 

Understanding the Standards 

While specific internal processes may vary, Cigna's credentialing program is designed to align with industry practices. The three-year recredentialing cycle, ongoing monitoring between cycles, and comprehensive verification requirements reflect standard approaches used across the healthcare industry. 

Providers should familiarize themselves with Cigna's specific credentialing requirements, which may be detailed in provider manuals, contracts, or available through Cigna's provider relations representatives. Requirements may vary by state, provider type, and line of business (medical vs. behavioral health). 

At WCH, we help providers navigate credentialing requirements across multiple payers, maintain compliance documentation, and address credentialing issues that arise. Effective credentialing management is essential for network participation and practice stability. 

Sources: 

• Cigna Healthcare. Provider credentialing and recredentialing documentation and requirements. 
• National Committee for Quality Assurance (NCQA). Industry credentialing standards. 
• State-specific Cigna provider manuals and credentialing guides. 

Read more articles