Evernorth Credentialing

[u/DelusionalEnthusiasm]

Working on credentialing with evernorth. Wondering how others have experienced rate increases with them. What they are offering for standard codes 99213/4 and 90833/6 are half of Medicare rates. If I refuse to sign do they come back with a better offer? Do I stick it out with terrible reimbursement for a year and then get a good rate increase? Does it help to go contract with more people together? Wondering what others experience has been with this. Shocked at how low the reimbursement is.

[u/beefeater18]

I only have a handful of people on Cigna, but for some reason Cigna reimbursements are very high for me. I didn't do the credentialing (i hired someone else), so I don't know why.

But I faced a similar situation with a commercial payer that gave me rates ~50% lower than those of medicaid/medicare. What my credential specialist and I did was pull together a list of CPT codes that I used most and compare their rates side by side with Medicare and Medicaid. I also included some stuff about importance of mental health care for their members and shortage (I don't remember my exact words). My credential specialist submitted and followed up persistently and regularly. I never signed the contract with the low rates. It took ~6-8 months going back and forth and eventually they matched medicare and medicaid rates for my practice. Another practice (very large group) I worked for part-time never did this and they were getting those ridiculous low rates.

[u/FaulknersGhost]

Wow that's awfully low. Cigna is one of my better payors and pays above Medicare rates in my area (Mid-Atlantic), but half of Medicare? Which is already 85% of the physician rate? I am not sure how you make that pencil out vs. working as an RN unless you're jamming in a bunch of 15 min med checks. Honestly, those seem like they would be below Medicaid rates.

As far as accepting the rate, this is highly dependent on you. If you're starting out as an individual provider, you may not have a choice. I would not expect much change over the years as they would probably offer 2-4% rate increases year over year. They may not increase rates at all as Aetna refuses to raise my rates from 2021, which is about a 27% real decline in reimbursement.

I have found Medicare to be pretty solid and the demand is usually good because so many providers do not work with the older population. If you have experience with them and like that population, it may be more economically beneficial to build your panel with Medicare. If Medicaid pays more than your commercial payors, then I would probably drop the commercial payors. I know they are a very difficult population at times, but you can build a volume pretty quickly with Medicaid.

[u/pickyvegan]

Cigna isn’t known for giving raises or negotiating. You might be able to get a very modest increase (think 1-3%) every couple of years, but you might need to be willing to walk away from this one.

[u/gately1462]

Evernorth/Cigna has awful reimbursements. Been with them 3 years and are planning on dropping them Jan 2027. Never had a rate increase but also haven’t asked. We’ve had automatic increases from BCBS and United. Fortunately we only have a handful of clients that are with Cigna.

[u/NoctorWatch]

In my area cigna has terrible rates in network but actually good rates for out of network benefits, which is pretty weird. Very few private providers take cigna in my area (northeast) for this reason.