Credentialing and Recredentialing

Join the CIGNA HealthCare network

You must meet our standard credentialing criteria to become a provider in a CIGNA HealthCare network. Recredentialing is required every three years in most states. The recredentialing process requires you to meet the same criteria as you did during the initial credentialing process.

Here are our credentialing criteria:

• signed application and agreement to participate (see below)
• verification of unrestricted state medical license with appropriate licensing agency
• verification of valid, unrestricted DEA certificate and CDS certificate, if required by the state
• 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
• review of work history (not needed for recredentialing)
• verification of prior sanctioning activities by regulatory bodies and by CMS
• review of malpractice claims history
• verification of adequate malpractice insurance
• proof of appropriate professional licensing (only for practitioners whose professions do not require medical licensure)
• on-site visit to PCPs, OB/GYNs and high-volume behavioral health specialists (not needed for recredentialing)

We encourage you to submit an application, attestation and authorization form using the Council for Affordable Quality Health Care (CAQH) Universal Credentialing DataSource application at http://www.caqh.org. Please contact our Customer Service Center first to ask about our need for additional providers in your specialty.

Once we verify all your credentialing information, we will present it to our health plan credentialing committee. This committee is composed of network physicians for peer review, and the CIGNA medical executive. If you are accepted for participation in our network, you will receive a "welcome" letter within 60 days of the date of the decision, or earlier, if required by state law.