Cigna Provider Enrollment: What To Expect

As a healthcare organization, you understand the importance of working with insurance payers to ensure smooth and timely reimbursement. The challenge is meeting each payer’s unique provider credentialing and enrollment process requirements.

In this blog, we’ll highlight how credentialers can navigate Cigna provider enrollment. We’ll walk you through the steps in enrolling providers with Cigna, the information and documents you’ll need, and best practices to follow.

Why Is Payer Enrollment Important For Healthcare Organizations?

Payer enrollment is a crucial step that allows your healthcare providers to participate in the network of a specific insurance payer. By enrolling with individual payers, your organization gains access to a wide range of patients with insurance coverage. In addition, being in-network with specific payers means your facility can provide healthcare services to its members at negotiated rates, leading to more stable revenue streams and better financial stability.

Benefits of Enrolling Your Providers With Cigna

Here are some key advantages of your organization enrolling providers with Cigna:

• Expanded Revenue Opportunities: Cigna has a large network of nearly 20 million members, and by enrolling your providers with Cigna, your organization gains access to a wider pool of potential patients. This will increase the company’s visibility and strengthen the financial viability of your organization and providers.
• Negotiated Reimbursement Rates: When your providers are in-network with Cigna, they can provide services to Cigna members at negotiated reimbursement rates. These rates are typically higher than what they would receive for out-of-network services, ensuring that your organization is fairly compensated for its expertise and services.
• Patient Trust and Confidence: Being in-network with a reputable insurance payer like Cigna can instill trust and confidence in the patients seen by your providers. Cigna members are more likely to choose providers within their network, and by being part of that network, your organization can attract and retain your organization can attract and retain more patients – and providers – and the revenue that comes with them.
• Collaboration and Referrals: Enrolling your providers with Cigna opens up opportunities for collaboration and referrals with other Cigna network organizations. This can lead to mutually beneficial relationships and help grow your organization’s professional network.

By enrolling providers with Cigna, you can tap into these benefits and position your organization and providers for long-term success.

Understanding The Payer Enrollment Process

Before enrolling healthcare providers with Cigna, it’s essential to have a clear understanding of the payer enrollment process. Here are the key steps:

1. Gather Training and Education
2. Gather Licensing and Certification
3. Gather Work History Details
4. Gather Payer-Specific Requirements
5. Following Application Submission

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Cigna Provider Enrollment Guidelines

Cigna Healthcare requires that credentialiers ensure providers meet standard credentialing criteria to become healthcare professionals in Cigna’s network. Recredentialing is required every three years in most states. The recredentialing process requires meeting the same criteria as during the initial credentialing process.

Here is a list of the information you’ll need to gather for Cigna credentialing:

• Signed application and agreement
• Verification of unrestricted state medical license with appropriate licensing agency
• Verification of valid, unrestricted DEA certificate
• Verification of full, unrestricted admitting privileges and good standing on the medical staff at a Cigna-participating hospital
• Board certification status with the American Board of Medical Specialties
• Review of malpractice claims history
• Verification of education and training
• Review of work history
• Verification of adequate malpractice insurance
• On-site visits to PCPs, OB/GYNs, and high-volume behavioral health specialists
• Verification of prior sanctioning activities
• Proof of appropriate professional licensing (only for practitioners whose professions do not require medical licensure)

Provider organizations can submit an application and agreement using the Council for Affordable Quality Health Care (CAQH credentialing) Universal Credentialing DataSource application.

Once Cigna verifies the information on the credentials, the health plan credentialing committee will receive the application. This committee comprises community physicians for peer review and the health plan medical director. If accepted for participation in the Cigna network, your provider receives a “welcome” letter within 60 days of the decision date or sooner if state law requires. For more information on how to enroll your providers in the Cigna network, visit Cigna Medical Network Credentialing.

Enroll Successfully The FIRST Time

MedTrainer Credentialing Software keeps all the necessary information for Cigna provider enrollment in one user-friendly place with proven workflows, customizable dashboards, one-click reporting, and automated reminders to keep tasks on track.

Our powerful software offers:

• Enrollment Applications Dashboard: Quickly assess and improve your enrollment process with dynamic graphs that show application age, average time to complete applications, and number of closed applications per credentialer. 
• Built-in Automation: Keep the enrollment process moving forward with automated reminders for providers to send documents, notification of recredentialing deadlines, and license expiration. 
• Highly Customizable Reports: With all credentialing data in one place, it is easy to customize reports for monthly payer submissions so that you can stay on top of due dates and status. Save reports for easy access, and schedule them to be emailed to internal and external recipients. 
• CAQH Profile Management: Streamline your enrollment processes with the most up-to-date provider information at your fingertips. Save time and improve provider onboarding and recredentialing with CAQH profile management. 
• Application Workflow Management: Simplify enrollment processing with a customized workflow, status, process checklist, notes, and task assignments. Easily assign multiple enrollments to staff, update statuses, and prioritize. 

Download our guide – Tools to Conquer Provider Enrollment – for valuable tips on speeding up the time from credentialing to enrollment approval. Schedule your demo to see MedTrainer Credentialing Software in action.