Becoming a CIGNA HealthCare participating provider can be beneficial to the Medical Office and its physicians. CIGNA HealthCare is one of the largest health insurance companies in the US that provide individuals and their families with health insurance coverage.
Participating with CIGNA HealthCare offers the medical office several opportunities:
- Become part of a global network of physicians and medical office practices known for meeting or exceeding quality and patient safety measures.
- Access to CIGNA HealthCare members searching for a participating provider in your area.
- Several practice management tools offered online that allow the medical office to verify member eligibility and benefits, check claim status, estimate patient liability, submit requests for prior authorization, and have access many more features.
Use the following steps as a guide to becoming a CIGNA HealthCare Participating Provider.
Step 1: Obtain a National Provider Identifier (NPI) and Other Identifiers
Prior to applying for participation in CIGNA's HealthCare network, providers which includes physicians, other clinical professionals, medical office practices and certain suppliers must obtain an NPI.
The National Provider Identifier or NPI is a 10 digit, unique identification number used to take the place of provider identifiers such as a Unique Provider Identification number (UPIN) in HIPAA standard transactions. Health care providers are required by regulation of HIPAA to obtain an NPI.
If you do not already have an NPI, apply for one at nppes.cms.hhs.gov or call the NPI Enumerator at 1-800-465-3203.
You will also need a UPIN, Medicare Provider number, and Medicaid Provider number on hand to help you fill out the application, when applicable.
Step 2: Join CAQH Universal Provider Datasource (UPD)
CAQH UPD is an online tool designed to simplify the process of gathering information required by health plans for provider credentialing and much more. This process prevents providers from having to submit the same information to multiple health insurance plans. Members can complete and submit their information to all health plans for free.
- Obtain a CAQH Provider ID by calling the CAQH Support Desk at (888) 599-1771 or email firstname.lastname@example.org
- Login at upd.caqh.org/oas/
- Follow instructions to complete and activate registration
Step 3: Complete the Application
The application process can be completed entirely online. Once the application is completed and attested, you will need to authorize CIGNA HealthCare to gain access to your enrollment application and other information. The entire process should take no longer than two hours to complete. The module is also designed to save your information if you need to complete the application in multiple sessions.
The CAQH support desk is available to assist you if you should need help during the process.
Step 4: Gather all supporting documentation
Any applicable supporting documentation must be faxed to CAQH at (866) 293-0414. You will need:
- Curriculum Vitae
- Medical license
- DEA certificate
- CDS certificate
- IRS Form W-9
- Malpractice insurance face sheet
- Summary of any pending or settled malpractice cases
In addition to the information required by CAQH, CIGNA HealthCare has their own list of documents and/or supporting criteria that may be requested.
- Verification of clinical privileges in good standing on the medical staff at a CIGNA-participating hospital
- Board certification status with the American Board of Medical Specialties or the American Osteopathic Association
- Verification of education and training
- Verification of prior sanctioning activities by regulatory bodies and by CMS
- On-site visit to PCPs, OB/GYNs and high-volume behavioral health specialists
Other Pertinent Information
- Entire process may take up to 3 to 6 months
- Allow 60 from decision date to receive welcome letter
- Depending on the physician or medical office specialty, information unique to your specialty may be requested in addition to the supporting documentation listed above
- Re-credentialing occurs every three years
- For more information about your medical office becoming a CIGNA HealthCare participating provider visit www.cigna.com and www.caqh.org