How to Get Credentialed with Cigna: A Step-by-Step Guide for Healthcare Providers

09/16/2024

Getting credentialed with Cigna is an essential process for healthcare providers looking to expand their patient base and receive reimbursements from this major insurance carrier. Whether you’re starting a private practice or managing a growing healthcare facility, navigating the credentialing process can feel overwhelming. However, with a clear understanding of the steps involved, you can simplify the journey.

Why Cigna Credentialing is Important

Cigna is one of the largest health insurance providers in the United States, serving millions of members nationwide. By becoming credentialed with Cigna, healthcare providers can:

  • Increase patient volume by becoming part of Cigna’s in-network provider list.
  • Receive timely reimbursements for services rendered to Cigna members.
  • Establish credibility and trust with potential patients.

What is the Credentialing Process?

Credentialing involves verifying a provider's qualifications, including education, training, experience, licensure, and certifications. For Cigna, the process ensures that healthcare providers meet the company's quality standards before they are allowed to serve its members.

Steps to Get Credentialed with Cigna

Here’s a breakdown of the steps to make your Cigna credentialing process smooth and efficient:

1. Obtain a National Provider Identifier (NPI)

An NPI is a 10-digit number that identifies you as a healthcare provider. You’ll need both an NPI Type 1 (individual provider) and possibly a Type 2 (for group practices or organizations). Cigna requires this for all credentialing applications.

2. Ensure Your CAQH Profile is Updated

The Council for Affordable Quality Healthcare (CAQH) serves as a repository for credentialing information. Most insurers, including Cigna, use CAQH ProView to verify provider information. Make sure your CAQH profile is up to date, accurate, and complete:

  • Upload current licenses, certifications, and liability insurance documents.
  • Confirm your work history and education details are current.
  • Provide detailed information about your specialty and practice.

3. Prepare Required Documentation

Cigna will ask for various documents during the credentialing process. These include:

  • State license(s)
  • Malpractice insurance certificate
  • DEA certificate (if applicable)
  • Hospital privileges (if applicable)
  • Educational background and professional references Having these documents ready will expedite the process.

4. Submit Your Application

Cigna accepts credentialing applications either through direct online submission or via CAQH. If you are applying as a solo practitioner or as part of a group practice, ensure that the right details are provided for each.

  • Solo Practitioners: Submit your individual NPI and CAQH details.
  • Group Practices: Submit both your Type 2 NPI and individual NPI for each provider in the group.

You can start the process through Cigna's credentialing portal.

5. Credentialing Review

Once Cigna receives your application, they will begin reviewing your qualifications. This includes verifying your licenses, malpractice history, work history, and any board certifications. The credentialing committee reviews this data to ensure you meet their provider standards.

The process typically takes between 60 to 90 days, but it can take longer if any issues arise or additional information is needed.

6. Contracting

After successful credentialing, you will need to sign a contract with Cigna. This contract outlines reimbursement rates, billing procedures, and other important terms. Review the contract carefully and ask any questions before signing.

Once you’ve signed the agreement, Cigna will add you to their network, allowing you to begin treating their members.

Common Challenges in the Credentialing Process

Credentialing with Cigna can sometimes be delayed due to various reasons. Here are some common pitfalls to avoid:

  • Incomplete or inaccurate CAQH profiles: Missing information or outdated documentation can slow down the process.
  • Licensure issues: Ensure your state licenses are active and up to date.
  • Slow responses: Timely communication with Cigna is key. Respond to any requests for additional information quickly to keep the process moving.
  • Unresolved malpractice claims: If you have pending claims, be prepared to provide additional documentation or explanation.

Tips to Streamline Your Cigna Credentialing Process

  1. Start early: Don’t wait until the last minute to begin the credentialing process. It can take several months to complete.
  2. Double-check your information: Before submitting your application, ensure all details in your CAQH profile are accurate.
  3. Keep your documents organized: Having your licenses, insurance certificates, and other required documents readily available will save time.
  4. Follow up regularly: Stay in touch with Cigna to track the status of your application and address any issues as soon as they arise.

What Happens After Credentialing?

Once credentialed, your practice will be listed in Cigna’s provider directory, making it easier for members to find and access your services. You’ll also be able to bill Cigna for services rendered to their members and receive reimbursements per the contract terms.

It’s important to maintain your credentialing status by keeping your CAQH profile and Cigna contract information up to date. Cigna may periodically re-credential providers to ensure ongoing compliance with their standards.

Final Thoughts

While the process of getting credentialed with Cigna may seem daunting, careful preparation and timely follow-through can make it smoother. By being proactive, organized, and communicative, healthcare providers can gain the benefits of being part of Cigna’s vast network, increasing patient reach and ensuring steady reimbursements.

If you’re looking for an automated way to handle credentialing, consider using CredyApp, a provider credentialing software that simplifies workflows and tracks the status of your applications across multiple payers, including Cigna.


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