Credentialing with a private insurer such as Cigna does **not** by itself prevent billing Medicaid for PT/OT services. The billing sequence depends on what insurance the individual client has, not on what insurances the provider is credentialed with.

The correct billing analysis:
– If a client has **Medicaid only**: Bill Medicaid (through the PASSE) regardless of whether you are also credentialed with Cigna.
– If a client has both **Cigna and Medicaid**: You must bill Cigna as the primary payer first (since Medicaid is payer of last resort), then bill Medicaid for any remaining cost-sharing.
– If a client has **Cigna only**: Bill Cigna.

The concern may arise if a provider’s Cigna contract contains an **exclusivity clause or coordination-of-care restriction** — review your specific Cigna contract terms. These clauses are uncommon for outpatient therapy but should be reviewed with legal counsel if you are uncertain.

Providers were encouraged to consult with a healthcare billing specialist or attorney if they are receiving conflicting information from their PASSE or Cigna about billing sequence for specific clients.