Network Provider Enrollment Form
Thank you for your interest in becoming a network provider.
Providers in Ohio and Kentucky (Boone, Campbell, and Kenton Counties only)
Please complete and submit the Network Enrollment Form below. Once submitted, a representative will contact you to discuss your eligibility for the network. When your eligibility has been confirmed, you will be forwarded the applicable network agreements.
The company’s receipt of your signed agreements does not guarantee participation in the company’s managed care networks.
Your participation is subject to your meeting the company’s credentialing requirements and acceptance of your application by a committee of network physicians.
See our privacy statement for more information about our policies.
Providers Outside of Ohio and Kentucky (Boone, Campbell, and Kenton Counties only)
Please contact Cigna to become a network provider in the Cigna® PPO network.