The Practitioner Conection
Volume XXVII, 3rd Quarter

NCQA PRACTITIONER SITE VISITS

CIGNA is accredited by the National Committee for Quality Assurance (NCQA) and strives to meet the quality standards set forth by NCQA. As a result, CIGNA instituted a new Practitioner Site Visit process in March 2008 to be in compliance with new NCQA standards. It is important for CIGNA's contracted practitioner network to be aware of this new process and to understand CIGNA's goals for the site visits.

If a customer calls CIGNA with a concern about the physical appearance or accessibility of an individual practitioner’s office or a clinic location, a site visit is now required. Typically, a member of CIGNA's Provider Relations Department will conduct the onsite visit. If CIGNA receives a concern about an office, the Provider Relations Representative assigned to the state will call the practitioner to review the concern and schedule a time for the site visit. On the agreed-upon date and time, the CIGNA representative will tour the facility. In addition to the concern which prompted the site visit, the CIGNA representative will also address quality standards which fall under the following categories: Physical Accessibility, Physical Appearance, Adequacy of Waiting and Examining Room Space, CIGNA Quality Measures and, as applicable, Home Office Facilities. Examples of the type of questions the site visit will answer include:

• Are there designated disabled parking spaces? (Physical Accessibility)
• Does the reception/ waiting area offer privacy from the treatment room? (Physical Appearance)
• Does the reception area offer ample space and seating for waiting patients? (Adequacy of Waiting and Examining Room Space)
• Are patient files locked and confidential? (CIGNA Quality Measures)
• Does the office have a separate entrance from the living area? (Home Office Facilities)

After the visit, the CIGNA representative will follow up with the practitioner to alert them of the outcome - either that there are no concerns about the office, or will provide a listing of any outstanding concerns. CIGNA appreciates that every office is unique and the representative will work with the practitioner to resolve any concerns as a result of the visit.

We would like to highlight that CIGNA does not view these site visits as punitive. While CIGNA is required to complete these visits to be in compliance with NCQA standards, the Provider Relations Department welcomes the opportunity to visit practitioner’s office locations. We also hope that practitioners feel free to raise any questions or concerns while the CIGNA representative is onsite.

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