Cigna Credentialing and Evernorth Behavioral Health

Cigna credentialing follows the pattern most large payers use. A CAQH-driven application, then primary source verification, then a committee, then contracting. Where it differs is behavioral health. That sits with Evernorth, not with Cigna itself, and it is where most of the wasted time goes.

This guide covers both routes. For the work, see our medical credentialing services.

Medical credentialing

• Cigna pulls credentials from CAQH ProView. So the profile has to be complete, currently attested, and open for Cigna to read.
• Expect a network need assessment: Cigna may decline to open credentialing at all if it considers your specialty adequately covered in your area. That is a faster answer than waiting 90 days for the same conclusion.
• Product participation is elected separately. Commercial, Medicare Advantage and any exchange products are not automatically included in one another.
• Group practices need a type 2 NPI and a group agreement, with each clinician credentialed and linked.

Evernorth Behavioral Health

• Independently licensed clinicians are credentialed individually; pre-licensed associates generally are not.
• Evernorth also draws on CAQH, so the same completeness and attestation rules apply.
• Panel status varies by county and license type, and closures are common in dense metros.
• Substance use treatment programs and higher levels of care have their own contracting track.

See insurance credentialing for therapists and mental health providers for the full carve-out map and how to argue a closed panel.

Cigna dental

Cigna's dental network is a separate application again, and DPPO and DHMO are typically separate elections within it. Dentists should read the leasing language before signing, see our dental credentialing services page for what to check in a dental PPO agreement.

What causes delays

• Sending a behavioral health application to Cigna instead of Evernorth
• Cigna or Evernorth not authorized to access the CAQH profile
• An attestation that lapsed during review: it is due every 120 days
• Assuming Medicare Advantage or exchange products are included in the commercial contract
• Work-history gaps over 30 days left unexplained

Work out which entity owns your network first

Nearly every wasted month in Cigna credentialing starts here. Cigna is not one queue. Medical, behavioral health and dental are handled by different parts of the business, and an application filed to the wrong one does not get passed along.

Before you fill in anything, answer three questions:

1. What is being credentialed: medical, behavioral health, or dental?
2. Which state is the practice in? Network arrangements differ by state.
3. Is this a commercial plan, a Medicare Advantage plan, or a Medicaid plan? Each is a separate contract even when the badge on the card is the same.

That last one surprises people. Being in network for Cigna commercial does not put you in network for Cigna's Medicare Advantage product. Patients arrive with a Cigna card, the practice assumes it is covered, and the claims deny as out of network.

When you call, ask which entity credentials your provider type for your state and your line of business, and write the answer down with the date and the name of the person who gave it. Credentialing is the part of this industry where that habit pays for itself.

Credentialing and contracting are two doors

Passing credentialing does not make you participating. Credentialing verifies the provider. Contracting sets the fee schedule and puts you in the network. You need both, and they finish at different times.

The letter at the end of credentialing reads like an approval, which is why practices start scheduling on it. Two things to get in writing before anyone books a patient: the effective date, and the tax ID the participation attaches to.

Claims dated before the effective date are not payable, and claims billed under a TIN that is not on the contract are not payable either. Groups meet the second version when they add an entity or restructure. A new TIN is a new contract, even with the same providers at the same address.

CAQH: the 120 day clock

Cigna pulls credentials from CAQH ProView rather than reading a paper file, so the quality of your CAQH profile decides how smoothly this goes.

Attestation expires every 120 days. Attesting is not filling in a form again, it is confirming that what is on file is still true, and it takes minutes. When it lapses the profile is flagged out of date, Cigna cannot pull it, and the application stops without a notification anybody reads.

Alongside the attestation date, two things have to be right:

• Cigna has to be authorized in ProView to see your profile. A complete profile with no authorization is a profile the plan cannot open.
• Documents inside the profile have to be current, particularly the malpractice certificate. An expired certificate stops the pull as surely as an expired attestation.

If an application has been silent for a month, check the attestation date before chasing anyone. It is the explanation more often than not.

Groups: rosters and delegated credentialing

Past a certain size, one application at a time stops being sensible. There are two better routes.

Roster submission lets a group send one structured file covering its providers instead of separate applications. It is faster and much easier to track, but the file has to match the required format exactly, and a rejection on formatting rarely comes with a helpful explanation.

Delegated credentialing means the plan audits your credentialing program and, if it passes, lets the group credential its own providers and report them. New hires then become effective in days rather than months.

Delegation has a real cost. You have to run a credentialing program that survives an audit: written policies, primary source verification, and a committee that meets and keeps minutes. It pays for a group hiring steadily. It is not worth building for two hires a year.

What you owe once you are in

Two obligations begin on your effective date, and both quietly cost practices money when ignored.

Directory verification. Federal rules require plans to confirm provider directory details at least every ninety days, and the plan passes that to you. Ignore the requests and you can be suppressed from the directory. Patients searching their plan's website stop seeing you, referrals fall, and nothing announces it.

Re-credentialing. The cycle is roughly three years. It is largely a re-check of what CAQH already holds, so a maintained profile makes it routine and a neglected one turns it into a fresh application with a gap in the middle.

Both are small jobs on a schedule. They are also the cheapest insurance available against losing a network you spent months joining.

Common reasons a Cigna application stalls

• Filed to the wrong entityBehavioral health sent to the medical network, or a Medicare Advantage application filed as commercial. It is not redirected.
• Lapsed CAQH attestationThe most common single cause, and invisible unless you look for it.
• Address mismatchThe practice address on the application does not match the state license board record. Verification stops there.
• Work history gapAny gap over six months needs an explanation in writing. Unexplained, it goes back for clarification and the clock restarts.
• Closed panelNot a problem with your file at all. Some networks are closed to new providers of a given type in a given county, and the only useful next step is to ask about the exception process.

How to become a Cigna behavioral health provider

If you are a therapist, counselor, psychologist, psychiatrist or PMHNP, becoming a Cigna mental health provider means joining the Evernorth Behavioral Health network. The Cigna behavioral health provider application is Evernorth's, not Cigna medical's.

• Independent license required LCSW, LPC or LMHC, LMFT, psychologist or PMHNP. Pre-licensed associates are generally not credentialed on their own.
• CAQH first Evernorth reads your CAQH profile, so it must be complete, attested and authorized before the request is worth sending.
• Network need Evernorth may decline where it considers the network full for your license type and area. Evening availability, a second language, a specialty or telehealth reach are the usual grounds for asking again.
• Group or solo A group needs its own type 2 NPI and agreement, with each clinician credentialed and linked to it.

Cigna credentialing phone number and status checks

Cigna and Evernorth publish separate provider service lines, and they change from time to time, so take the current number from the provider section of the site you applied through rather than from an old list. Calling the medical line about a behavioral health application is the most common wasted call.

Have your NPI, tax ID, CAQH number and application reference ready. Before you call, check your CAQH attestation date and that Cigna is authorized to view the profile; most applications that have gone quiet are waiting on one of those.

Cigna EAP and Evernorth: not the same participation

Employee assistance program sessions run under different rules from the behavioral health benefit. They are usually pre-authorized for a set number of sessions, and they may need a separate agreement or an addition to yours. If you want EAP referrals, ask whether your Evernorth agreement covers them before you see an EAP client.

Related

• The work itselfMedical credentialing and provider enrollment services
• Therapists and prescribersInsurance credentialing for therapists