To ensure providers adhere to Cigna's credentialing criteria, provider applicants are screened using industry standards, such as those issued by states, Medicare, Cigna and the National Committee on Quality Assurance (NCQA)¹. Cigna confirms provider information through the credentialing process which requires a contract, a signature attesting to application data and attachments, and verification of credentials.

Each provider undergoes an initial assessment and reassessment at least every three years. In addition, Cigna continues to monitor the status of the provider between the 3 year cycles using regulatory reports, complaints and other information received from external resources (i.e. television news, newspaper, community reputation, etc.). All data collected receives a robust review by the Cigna Credentialing Committee made up of peer provider participants. The Credentialing Committee assesses each provider’s credentials to ensure they meet Cigna's credentialing criteria. Cigna's credentialing criteria include but are not limited to the following:

• Signed agreement to participate
• Signed and completed standard or state-mandated application
• State medical license
• Professional liability coverage
• Admitting privileges, if applicable
• Other active licensure such as DEA/CDS, if applicable
• Education and training including board certification, if applicable
• Sanction activity
• History of employment

Cigna participates in the Council for Affordable Quality Healthcare (CAQH) collaborative. CAQH provides the Universal Credentialing DataSource, a standard application source completed once by the practitioner helping to eliminate redundant requests for the same information from multiple organizations. Providers can submit an application, via CAQH at www.caqh.org.

Providers have certain rights during the credentialing and recredentialing process which include the right to:

• Review information submitted to support credentialing application. Information from outside sources (i.e. licensing boards, etc.) will be made available for review. Providers may exercise this right by contacting the Credentialing Department at 1.800.88Cigna (1.800.882.4462).
• Correct erroneous information. When erroneous information is present, providers are contacted in writing by a representative from the Credentialing Department and notified of the discrepancy. Corrections should be submitted to the Credentialing Department in writing within 15 business days at the location as noted on the request. All responses are recorded with a date of receipt and maintained as part of the provider’s credentialing file.
• Receive the status of their credentialing or recredentialing application, upon request. Providers may contact 1.800.88Cigna (1.800.882.4462) to inquire about the status. While the application review process is occurring, through discussion with a representative from Provider Services Unit, Provider Data Management or Credentialing, depending on where the request is received, practitioners are informed of the status of their credentialing or recredentialing application. Communicating the status of the application may be done electronically or verbally. Verbal inquiries are responded to immediately whereas electronic inquiries are responded to within 15 days.

¹ NCQA is a private, non-profit organization dedicated to improving health care quality