Section 2

Practitioner Selection

The foundation of the Cigna Behavioral Health approach to quality management is identifying, credentialing, and contracting with providers who deliver care consistent with our clinical quality program. Our goal is to establish and maintain a panel of providers whose standards of practice individually and collectively are consistent with Cigna Behavioral Health's standards.

The Cigna Behavioral Health network is comprised of physicians, psychologists, nurse practitioners, physician assistants, and masters level clinicians. In order to be considered for inclusion, all individual providers, with the exception of physician assistants, must be currently licensed to practice independently in the state(s) in which they will be contracted with Cigna Behavioral Health and maintain a minimum practice of 24 clinical hours per week, including both outpatient and/or inpatient work.

If the practitioner provides services from a home-based office, the office must meet the following requirements:

• The office must be used solely for practice.
• If in-person treatment is occurring, the home office must have a separate entrance from the living area.
• The office space and any other patient areas (treatment rooms, waiting rooms, bathrooms, etc.) must be separate from the living area.
• The office space and any other patient areas (treatment rooms, waiting rooms, bathrooms, etc.) must be clean, and free of smoke, animals (except service) and personal effects.
• If in-person treatment is occurring, the office must have a waiting room separate from the living area that offers privacy from the treatment room during appointment hours.
• The office telephone line must be on a separate line from the residential line.
• Medical records must be secured in a locked file and/or room, out of sight of patients.

Providers selected for participation must successfully complete a thorough screening, contracting, and credentialing process. All information obtained in the credentialing process is confidential, except as otherwise provided by law. Cigna Behavioral Health recredentials each contracted practitioner every three years.

If the practitioner meets the credentialing criteria and a contract is extended, the Agreement will include all lines of business. Cigna Behavioral Health utilizes eSignature for contracting. Practitioners will receive the contract packet via email in order to electronically sign and return the Agreement. Cigna Behavioral Health will execute the Agreement via an electronic signature and send the executed agreement back to the practitioner via email. The Cigna Behavioral Health Agreement is specific to practitioner, rather than to location or Tax Identification Number. Practitioners must treat all Cigna Behavioral Health participants equally and must behave as contracted at all service locations.

Supplementing those processes, a review of medical records of high volume practitioners occurs annually. Semiannually, Cigna Behavioral Health reviews all reported complaints about providers and adverse events to detect any patterns or trends that might require investigation. Licensing board and Medicare/Medicaid actions are monitored monthly.

Practitioner Credentialing

Cigna Behavioral Health uses the Council for Affordable Quality Healthcare's (CAQH) credentialing application to assist in our network credentialing process. This application is used for credentialing new behavioral health providers to the Cigna Behavioral Health network and to recredential our current network behavioral health providers.

If you have not used CAQH before, simply access their online application at www.CAQH.org/cred and complete the application. Once you have finished, you will be required to attest that your information is complete and accurate. Please also be sure to authorize Cigna Behavioral Health for access to your data so that the credentialing or recredentialing process can continue.

After the CAQH application is completed, providers will need to reattest to the information originally submitted (or make any necessary updates) every 120 days. When providers consistently reattest through CAQH, no additional outreach from Cigna will be necessary at the time of recredentialing.

However if this information is not reattested consistently, Cigna will contact the provider six months prior to the recredentialing date. A minimum of two outreach attempts will be made to encourage the provider to reattest. If the provider has failed to respond after these attempts, pre-termination notice will be sent by certified mail in accordance with state compliance laws and Cigna contracting guidelines.

Please also note that it is very essential that our network providers keep their demographic information (addresses, telephone numbers and email addresses) up-to-date in the CAQH application and with Cigna Behavioral Health. This will ensure that we can contact you promptly regarding any recredentialing issues.

Behavioral health providers who have questions or need help with completing their CAQH application can contact CAQH directly:

Contact information for CAQH

Help Desk: 888.599.1771

Fax: 866.293.0414

Website: www.CAQH.org/cred

Practitioner Rights and Responsibilities

Contracting and Initial Credentialing

Prospective providers can apply directly online with our enhanced Cigna Behavioral Health Provider Application. Cigna Behavioral Health will respond by email within six weeks after reviewing the application.

If you have any additional questions or concerns, you may also call our Provider Services Center, at 800.926.2273.

If you practice in Minnesota, North Dakota or western Wisconsin:

In these markets, Cigna's behavioral network represents an alliance between Cigna and HealthPartners. For contract consideration, please complete the HealthPartners Behavioral Health Contract Inquiry at https://www.healthpartners.com/provider-public/forms-other/contracting-inquiry/provider-type.html.

If you practice in Missouri:
For the status on where you are in the credentialing process, please email us at BehavioralContracting@cigna.com. Please include your name and Tax Identification Number.

Recredentialing and/or Access to Credentialing/Recredentialing File

If you have any questions about recredentialing, please use the contact information below.

At any time, Cigna Behavioral Health practitioners may request, in writing, information contained in the practitioner file that was submitted in support of the practitioner's credentialing/recredentialing application. The request for review is to be directed to the Credentialing department (see below). Cigna Behavioral Health will make arrangements for this review as soon as possible after receiving the request.

• Phone: 800.926.2273
• Email: BehavioralHCPEnrollment@Cigna.com
• Mail: Cigna Behavioral Health - Attn: Credentialing
  11095 Viking Drive, Eden Prairie, MN 55344

Credentialing/Recredentialing Discrepancies

If significant discrepancies are identified between the information on your application and information obtained in the external verification process, you will be contacted within five days of the discovery, and given the opportunity to clarify or explain the discrepancies.
In this situation, Cigna Behavioral Health will request a written response, due within 30 days. Your response and the recommendations of the Provider Relations department will be forwarded for review to the Credentialing Committee. The Committee has authority to approve or disapprove your inclusion in the network. You will be notified in writing, within 30 days, of the Committee's final decision if you are being credentialed for the first time. You will not receive any notice if you are being recredentialed.

Practitioners Right to Correct Erroneous Information

You have the right to correct erroneous information submitted by another party or to submit a more detailed explanation of the information you had previously sent. However, the right to correct information does not apply to the Credentialing Questionnaire, because you attested to the correctness of the information upon submission.

Specialty Privileging

When you complete the provider application you will be asked to identify those specialties in which you consider yourself a specialist. Each month a Specialty Privileging audit is done on a random sampling of practitioners who were accepted into the network the previous month. Those practitioners selected for the audit will be asked to submit documentation that supports their specialty selections. Documentation may include evidence of formal education in a particular specialty, an accumulation of CEUs in that specialty area, or a resume that demonstrates extensive experience in that specialty.

Please be aware that any and all changes associated with your practice, such as change of address, hours, phone number, specialty, additional certification, insurance, etc., must be reported to Cigna Behavioral Health as soon as possible. These changes should be submitted within 30 days. Visit the "Working with Cigna" section of your secure dashboard. The easy-to use online forms can be found within the Profile Information area.

Appeal of Suspension or Termination of Agreement Privileges

If a practitioner is notified that network participation has been suspended or terminated by Cigna Behavioral Health, the practitioner may contact the Manager of Network Operations identified in the notification or the Provider Relations department to discuss the suspension or termination.

There is the option of a formal appeal of the suspension or termination of Agreement privileges. The practitioner may request reconsideration by sending a letter to the Manager of Network Operations. This letter must describe the reason for requesting reconsideration and include any supporting documentation. The practitioner has thirty (30) days from the receipt of the suspension or termination letter to make a written request for reconsideration. Cigna Behavioral Health's Credentialing Committee Appeal Panel will review the appeal at its next monthly meeting and issue a written notification of the outcome to the practitioner. The Appeal Panel is composed of at least three clinicians, none of whom were involved in the decision being appealed. One of the clinicians will be from the same discipline as the appealing practitioner.

The practitioner and/or their representative may choose to attend the meeting either in person or by conference call. They must notify Cigna Behavioral Health of their desire to participate at least three (3) working days prior to the meeting so appropriate arrangements can be made. The provider will be notified within five (5) working days of the committee's decision, including the reason for the decision.

A practitioner who is dissatisfied with the decision of the Credentialing Committee may pursue arbitration as outlined in the Dispute Resolution Procedure section of the Participating Provider Agreement. A sixty (60) day time limit exists for the pursuit of arbitration, following the decision rendered by the Credentialing Committee or Appeal Panel. Practitioners who contact the American Arbitration Association should request all documentation be forwarded to:

General Counsel
Cigna Behavioral Health, Inc.
11095 Viking Drive, Suite 350
Eden Prairie, MN 55344

The Participating Provider Agreement renews automatically every year on the anniversary date of the Agreement. Either Cigna Behavioral Health or the practitioner can choose not to renew the Agreement with a written sixty (60) day notice to the other party. For non-renewal of your Agreement privileges, there is no right of appeal.

In those states where there are laws regulating the appeal process, the state law supersedes this process

Frequently Asked Questions

I am moving and need to change my address or I am changing my Tax Identification Number or legal name.

These changes should be submitted to Cigna within 30 days. Log in to Cigna for Health Care Professionals ( CignaforHCP.com) > Working with Cigna > Update Provider Information.

Mail or Fax:	Online:
Network Operations Fax # 860.687.7257	Cigna for Health Care Professionals website (www.CignaforHCP.com)
Cigna Behavioral Health
11095 Viking Drive, Suite 350
Eden Prairie, MN 55344

If you are moving to another state, or leaving a group practice that contracts with Cigna Behavioral Health, your agreement/participation at your old location will be terminated. You must contact the Provider Relations department for your new location so that a new contract can be prepared.

I want to update my self-introduction

Complete the Provider Self-Introduction Form (see Appendix D) and email it to Cigna Behavioral Credentialing at CELTeam@Cigna.com.

Why is money being withheld from my reimbursement checks?

The reduction for backup withholding is a reflection of taxes withheld due to instruction from the Internal Revenue Service. You will need to contact our Accounts Payable department at 800.433.5768 to obtain the forms needed to correct any discrepancy. All other questions should be directed to Provider Services at 800.926.2273.

I want to obtain information about MCG Behavioral Health Guidelines or The ASAM Criteria (f/k/a Level of Care Guidelines).

Visit us online at the Coverage Policies page, see Supporting Behavioral Websites.

I would like a copy of my Cigna Behavioral Health provider agreement.

You may either mail or fax a request for a copy directly to Network Operations (see address above)

I want to terminate my agreement with Cigna Behavioral Health.

Our agreement permits you to terminate annually on renewal, however, Cigna Behavioral Health, in its discretion, may permit you to terminate earlier, but in no event with less than 90 days' notice. Send your written request for termination by certified mail to the Provider Relations department at your Regional Care Center (see Appendix A).

I received a termination notification of my Cigna Behavioral Health provider agreement and would like to appeal this decision.

Address a letter of appeal to:

All Practitioners except-
California Practitioners

Network Operations
Cigna Behavioral Health, Inc.

11095 Viking Drive, Suite 350
Eden Prairie, MN 55344

California Practitioners

Provider Relations Department
Cigna Behavioral Health of California, Inc.
400 North Brand Boulevard
Glendale, CA 91203

I have not been receiving any referrals from Cigna Behavioral Health.

Practitioner selection is based on participant preference and practitioner's specialty, geographic proximity, and availability. If you have any further questions, contact your Provider Relations department.

Most Important Reasons to Contact Your Provider Relations Department

To limit or stop referrals for a period of time.
To add/change a specialty or service.
To ask specific question(s) in reference to your agreement.

Should you have further practitioner network questions, please refer to (see Appendix A) to contact your Provider Relations department.