Question

From a quality perspective, what criteria should be included in the credentialing and recredentialing processes. Please respond with at least one credible citation.

Answer 1

To ensure providers adhere to Cigna's credentialing criteria,provider applicants are screened using industry standard,such as those issued by states,Medicare,Cigna and the natoinan Committee as Quality Assurance (NCQA)1.Cigna confirm provider information through the credentialing processes which requires a contract,a signature attesting to application data and attachment,and varification of credentials.

Each provider under goes an initial assessment and reassesment at least every three year.The Credentialing Committee assesses each provider,s credential to ensure they meet Cigna's credentialing criteria.Cigna's credentialing criteria included but are not limited to the following:

*Signed and completed standard or state -mandated application.

*Signed agreement to participate.

*Professional liability coverage.

*Admitting privileges ,if applicable

*State medical license

*Other active licensure such as DEA/CDS,if applicable

Education and training including board certification

*Sanction activity

History of employment

Providers have certain right during the credentialing and recredentialing process which include the right to:

Review information submitted to support credentialing application.Information from outside sources will be made available for review.

Correct erroneous information.

Receive the status of their credentialing or recredentialing application,upon request.providers may contact.