CIGNA Behavioral Health Practitioner Connection

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11095 Viking Drive
Suite 350
Eden Prairie, MN 55344
Telephone: 952.996.2000
Fax: 860.867.7257

ProviderEducationSpecialist@
CIGNABehavioral.com

CBH Practitioner Conection
Volume XXIII, 3rd Quarter

The right help at the right time!

Facts About Re-credentialing

CIGNA Behavioral Health (CBH) re-credentials our participating practitioners every two or three years, depending on state requirements. Practitioners must meet established credentialing standards that protect our participants and promote the quality of our network. Unfortunately, not all of our practitioners complete the re-credentialing process within the given timeframe.

Practitioners are sent 4 to 6 notices starting 3 months in advance of their re-credentialing due date from one of our credentialing information organizations, either CAQH (Council for Affordable Quality Healthcare) or Aperture/Ingenix. These notices may be sent by U.S. mail, facsimile, or email and include directions on how to complete re-credentialing in a timely manner. One month prior to the due date, practitioners are also sent a certified letter from CBH notifying them that if they do not complete their re-credentialing within the required timeframe, their contract will be terminated.

If re-credentialing is not completed by the practitioner’s specified due date, then their contract enters the termination process. At this point, the practitioner has the option to remain non-participating or reapply to the network. Network re-acceptance is not guaranteed, but contingent upon several factors, such as the number of current participants, specialties, geographical need, and compliance history with the re-credentialing process.

If a practitioner is re-accepted into the network, they still face several challenges. Generally, a re-credentialing due date is 90 days prior to the contract’s termination date. Once a practitioner has missed the re-credentialing due date, they have 90 days (prior to the contract termination date) to reapply and complete the credentialing process in order to retain participating status. If a practitioner is unable to complete the process within the 90 days before their contract terminates, this may create coverage problems for participants and payment problems for the practitioner.

If a practitioner does not re-contract before their termination date they will be considered non-participating and participants will either have to pay out-of-pocket and/or utilize their out-of-network benefits for that practitioner’s care. The best way to avoid contract/coverage problems and help minimize the effect of any unexpected errors or delays is to complete re-credentialing as early as possible.

We encourage practitioners to contact the appropriate provider relations staff for inquiries related to their re-credentialing should they need assistance.