Cigna credentialing: CAQH-based verification with behavioral health routed to Evernorth.
Cigna credentials nationally from CAQH data, with a structure similar to other large commercial payers. The two things that trip practices up are behavioral health, which is administered through Evernorth, and the assumption that credentialing approval means you can bill as in-network.
Key takeaways
- Behavioral health goes through Evernorth. Mental health and substance use practitioners credential separately from the medical network.
- CAQH drives the application. Cigna verifies from ProView, so gaps and lapsed attestation stall progress.
- Contracting is the participation step. Credentialing verifies the provider; only an executed contract creates network status.
- Recredentialing is cyclical and enforced. Missing the cycle can suspend participation without a practical grace period.
How Cigna credentialing works
Cigna operates a centralised credentialing process drawing on CAQH ProView, with participation requests and contracting handled through its provider portal. Primary source verification covers licensure, education, board certification, malpractice history and sanctions, after which the file goes to a credentialing committee. As with other national commercial payers, the quality and currency of the CAQH profile is the largest single determinant of how quickly this moves.
Behavioral health is administered by Evernorth, Cigna's health services organisation, with its own credentialing pathway, contracts and network decisions. Practices with both medical and behavioral practitioners run two parallel processes, and routing a therapist or psychiatrist through the medical pathway generally results in an application that stalls rather than one that is formally declined. Confirming the pathway before submission avoids months of silence.
Step by step: how to do it
- Complete and attest CAQH ProViewPopulate all sections, explain any work history gaps, upload current documents and authorise Cigna to access the profile.
- Determine medical or behavioral routingMedical practitioners go through Cigna; behavioral health practitioners go through Evernorth. Confirm before submitting anything.
- Submit the participation requestApply through the Cigna provider portal with practice details, service locations, specialties and the products sought.
- Complete credentialing verificationCigna performs primary source verification and presents the file to its credentialing committee.
- Review and execute the contractConfirm fee schedule, products and networks included, and the effective date, then execute.
- Confirm identifiers, directory and effective dateRecord Cigna provider identifiers, verify the directory listing, and hold claims until the effective date.
- Diarise recredentialingTrack the recredentialing cycle centrally so participation is never suspended for a missed deadline.
Where to go: portals and systems
| System | Address | What it is used for |
|---|---|---|
| CAQH ProView | proview.caqh.org | Credentialing data source used in verification |
| Cigna provider portal | cignaforhcp.cigna.com | Participation requests, contracting, claims and eligibility |
| Evernorth Behavioral Health | evernorth.com | Behavioral health credentialing and contracting |
| NPPES | nppes.cms.hhs.gov | NPI and taxonomy maintenance referenced during verification |
Documentation and licensing requirements
| Requirement | Why it is required |
|---|---|
| CAQH profile, attested | Primary credentialing data source; must be current and authorised to Cigna |
| Active state licence | Current and unrestricted for every state where services are delivered |
| DEA registration | Where controlled substances are prescribed, matching the practice address |
| Board certification | Supports the specialty claimed and can influence network acceptance |
| Malpractice insurance | Current certificate meeting minimum limits in the correct entity name |
| W-9 and tax identification | Legal name and TIN matching the entity that will be paid |
| Practice location and accessibility detail | Service addresses, hours and accessibility attributes for directory accuracy |
Common application denials and how to fix them
| Reason | Why it happens | How to fix it |
|---|---|---|
| Wrong pathway | Behavioral practitioner submitted to the medical network | Resubmit through Evernorth; medical pathway applications for behavioral providers stall rather than process |
| CAQH not accessible | Profile unattested or Cigna not authorised | Re-attest, grant authorisation and request the application resume |
| Work history gap | Employment break not explained | Provide a written account covering the whole period |
| Entity or TIN mismatch | W-9 details differ from the billing entity | Align legal name, TIN and billing entity across all records |
| Network closed | Cigna not adding providers in that specialty and area | Submit an access-based reconsideration; consider single-case agreements meanwhile |
| Recredentialing lapsed | Cycle deadline missed | Complete immediately; participation may be suspended until it is resolved |
Confirm whether each practitioner belongs to Cigna or Evernorth before you submit anything. Behavioral applications sent to the medical network typically produce silence rather than a rejection, so practices wait months assuming the file is progressing. A two-minute check at the start prevents the single most common source of delay with this payer.
Do and don't
- Route behavioral health practitioners through Evernorth from the outset.
- Keep CAQH complete, attested and authorised to Cigna.
- Confirm both credentialing approval and contract execution in writing.
- Verify the directory listing after approval.
- Track recredentialing cycles centrally with a named owner.
- Don't submit behavioral providers through the medical pathway.
- Don't treat credentialing approval as network participation.
- Don't bill as in-network before the contract effective date.
- Don't leave work history gaps unexplained in CAQH.
- Don't let recredentialing lapse.
Frequently asked questions
Why has our Cigna application gone quiet?
The most common cause is a behavioral health practitioner submitted through the medical pathway. Those applications tend to stall rather than generate a formal rejection, so nothing arrives to tell you the file is not progressing. The second most common cause is a CAQH profile that is unattested or not authorised for Cigna, which halts verification before any human review. Check both before chasing status.
What is Evernorth and when do we use it?
Evernorth is Cigna's health services organisation, and it administers behavioral health credentialing, contracting and networks. Therapists, psychologists, psychiatrists and substance use treatment providers generally credential through Evernorth rather than the Cigna medical network. Practices with both medical and behavioral clinicians need to run both processes in parallel, with separate contracts and separate effective dates.
Does credentialing approval mean we are in network?
No. Credentialing verifies the practitioner's qualifications; the executed contract establishes network participation, the products included and the fee schedule. Both are required. Seeing Cigna patients on the strength of credentialing approval alone results in out-of-network processing, which creates a revenue shortfall and a patient balance issue that is awkward to unwind afterwards.
How do we handle a closed network?
Approach it as a commercial matter rather than a credentialing one. Build a reconsideration around access: an underserved area, a subspecialty the network lacks, extended hours, language capability or a referral pattern currently leaving the network. Single-case agreements can cover urgent individual cases in the interim. Networks reopen periodically, so keep the request live and revisit rather than treating a closure as final.
Can you run Cigna and Evernorth applications together?
Yes. We route each practitioner to the correct organisation at the outset, maintain a single accurate CAQH profile that both can draw from, track the two processes separately with their own committee timelines and effective dates, and confirm contract execution before advising that any provider is billable. Recredentialing for both is tracked on the same central calendar.
Want Cigna credentialing handled end to end?
We prepare, submit and chase applications on a schedule, keep CAQH attested, and tell you the week each provider becomes billable.