California provider directory update requirement

April 1, 2024

California Senate Bill (SB) 137 requires health plans to contact all contracted providers to verify the accuracy of the information they have in their provider directories. This must be done:

  • Once every year for ancillary providers and physicians who are affiliated with a provider group.
  • Once every six months for individual physicians who are not affiliated with a provider group.

Information we are required to verify by law

Practitioner or associationFacility and ancillary providers
NameName
Alias (alternate) nameAlias (alternate) name
Email (for patient communications)Facility or ancillary type
DegreeLicense
SpecialtiesAccreditation status
Board certificationNPI
National Provider Identifier (NPI)TIN
License(s)Servicing addresses, including phone numbers
Language(s) (including staff and qualified medical interpreters)Network plan types accepted (e.g., PPO, OAP, HMO)
Facility and hospital affiliationsEmail (if available)
Taxpayer Identification Number (TIN) 
Accepting new patients/panel status 
Network plan types accepted (e.g., PPO,* OAP,* HMO,*) 
Servicing addresses, including phone numbers 
Medical group affiliation(s) 

Your responsibilities under California SB 137

In compliance with California SB 137, and under the terms of your Cigna Healthcare Provider Agreement, you are required to validate the accuracy of the information displayed in our provider directories and to keep this information current. California SB 137 requires us to remove providers from our directories if, after multiple attempts to reach them, we do not receive a response to validate the information.

Accordingly, you must:

  • Respond to initial notices sent by Cigna Healthcare (or a group or entity on behalf of Cigna Healthcare) within 30 business days, to either confirm your directory information is current and accurate or submit an update to your directory information.
  • Respond to any second notices within 15 business days. You will receive this notice if you did not respond to the first directory verification notice, or if you responded with only partial or inaccurate information that cannot be verified by Cigna Healthcare. If you do not respond to this notice, you will be suppressed from showing in online and printed directories.

In addition:

  • If changes to your demographic information occur outside of our verification time frames, in compliance with the law you must inform Cigna Healthcare within five business days if your practice no longer accepts new patients, or if you previously did not accept new patients and now you do accept them.
  • If customers with Cigna Healthcare-administered coverage who are not your patients contact you to make an appointment, and you do not accept new patients, direct them to call Customer Service at the telephone number on the back of their Cigna Healthcare ID card for assistance in finding another provider.

Restore your listing

If you have received notification that your information has been removed from our provider directories, you can still confirm that your information is accurate or request that we update it by sending an email to CA_DirectoryCompliance@Cigna.com. We will restore your information in the online and printed directories once we receive a full and accurate response, and are able to verify it in accordance with Cigna Healthcare policies and requirements for updating directory information.

Other times to update your demographics

If your demographic information will change during a time frame that is outside of our annual or semiannual verification process, we require that you notify us 90 days in advance. Not only will this help ensure the accuracy of your information in our provider directories, it may prevent reimbursement delays that could occur if you make changes to certain information (such as your name, address, TIN, or NPI). Changes to the directories will be made within 30 business days of the date we receive your request.

Three easy ways to submit demographic updates

Type of demographic updateWebsite or email address
Routine**Log in to the Cigna for Heath Care Professionals website (CignaforHCP.com) > Working with Cigna. Go to the Update Demographic Information section; click Update Health Care Professional Directory.*** or Intake_PDM@Cigna.com
Directory correctionsProviderUpdates@Cigna.com

View the current provider directory

Go to Cigna.com > Find a Doctor. Then select a directory.

We appreciate your cooperation and compliance with this law.

* Preferred provider organization, Open Access Plus, health maintenance organization.

** Cannot make directory corrections.

*** Cannot update TINs using this method. Please send an email to Intake_PDM@Cigna.com.

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