Get Credentialing Application Template

Credentialing is "the process of assessing and confirming the license or certification, education, training, and other qualifications or a licensed or certified healthcare practitioner." Privileging is "the process of authorizing a health care practitioner's specific scope and content of patient care services."

As I mentioned above, being credentialed means the provider(s) is loaded into the insurance company's system. Normally when you are only credentialed, it means you are out of network with the insurance company. Now, contracting is the process of becoming in network with the insurance company.

Provider credentialing is a regulated process of assessing the qualifications of specific types of providers. This important safety check requires providers such as doctors, dentists, and other allied healthcare professionals to show they have the proper education, training and licenses to care for patients.

Is credentialing the same thing as contracting? No, credentialing is the process of reviewing the doctor's qualifications while contracting is the process of applying for and obtaining participation contracts with insurance plans.

While medical credentialing is an essential process to certify a provider's qualifications, payer enrollment is the process of requesting participation in a health insurance network as a medical provider.

Please call Cigna Provider Services at 1 (800) 88Cigna (882-4462). Choose the credentialing option and a representative will assist you.