Health care professionals:
Joining the network FAQs

What is credentialing?  
Credentialing is a systematic approach to the collection and verification of a provider's professional qualifications. The qualifications that are reviewed and verified include, but are not limited to, relevant training, licensure, certification, and/or registration to practice in a healthcare field, and academic background. Additionally, Aetna conducts an assessment of whether the provider meets certain criteria relating to professional competence and conduct. The Aetna credentialing process evaluates the qualifications of providers prior to caring for Aetna members.

Aetna's Credentialing Verification Organization (CVO) meets the National Committee for Quality Assurance (NCQA) standards for health plans. In addition, Aetna’s CVO maintains accreditation by URAC for meeting strict quality standards.

Interested in applying for participation in an Aetna Network?
Aetna evaluates each provider's request for participation with Aetna’s Health Plans against the current need to service the membership in a specific geographical area. Providers can complete a request for participation on-line at http://www.aetna.com/about-aetna-insurance/contact-us/forms/doctors_hospitals/index.html or by contacting one of the following numbers:

• Individual Medical Provider: Complete the online Health Professionals - Medical Plans Application Request form or contact 1-800-353-1232  
• Dental Providers (excluding oral/maxillofacial surgeons): 1-800-451-7715
• Behavioral Health Providers: Complete the online Health Professionals - Behavioral Health Application Request form  Medical Plans or contact 1-800-999-5698

I've heard of an organization called the Council for Affordable Quality Healthcare or CAQH. Can you tell me more about this organization?  
Many health plans ... one solution! The Universal Provider DataSource was developed by America’s leading health plans collaborating through the Council for Affordable Quality Healthcare, or CAQH. The Universal Provider DataSource is the leading industry-wide service to address one of providers’ most redundant administrative tasks: the credentialing application process.

Under the CAQH program, providers use a standard application and a common database to submit one application, to one source to meet the needs of all of the health plans and hospitals participating in the CAQH effort. To maintain the accuracy of the provider’s data, CAQH will send a reminder every 120 days for providers to re-attest to their information. Health Plans and hospitals designated by the providers will obtain the application information directly from the database, eliminating the need to have multiple organizations contacting the provider for the same standard information. Providers update their information on a quarterly basis to ensure data is current and accurate. CAQH will gather and store detailed data from more than 960,000 providers nationwide.

Want to learn more about the CAQH Universal Credentialing Data Source? Visit the CAQH website 

Where can I find more information about Aetna's Participation with CAQH's online application?  

• Aetna utilizes the CAQH Universal Provider DataSource for our credentialing needs for all provider types.  
• Just fill out the Healthcare Professionals –  Medical Plans Application Request form or if you are a Behavioral Health provider complete the  Health Professionals - Behavioral Health Application Request form and we will add you to our CAQH – Aetna Provider Roster
• If you have already registered with CAQH or have received registration information from CAQH, no further correspondence will be sent to you. Please ensure you have granted "Aetna" authorization to review your information 
• If you have not completed CAQH’s the online registration, you will receive a registration kit from CAQH within 7 – 10 business days. Once you receive your registration kit, complete the CAQH application and be sure to grant "Aetna" authorization to review your information. 
• Once you complete the CAQH application, Aetna obtains your application data electronically and begins the credentialing process.

For more information about the CAQH roll out schedule and participating Heath plans, please visit the CAQH online application site at  http://www.caqh.org/.

If I have not yet registered with CAQH, what are my next steps?  
Simply fill out the Aetna application request form (see above) and we will enter your name in our New Provider Applicant Roster. A new provider registration package with your secure ID number arrives at your doorstep in 7-10 business days.

What happens next? Can I begin seeing Aetna members once I submit my application for participation?  
Once Aetna receives your completed application for participation, your information will be evaluated against Aetna’s business requirements and your credentials will be validated as described in the "What is Credentialing" section above. Once this process is complete, you will receive written notification that your credentialing is complete. The credentialing and contracting processes are separate; your Aetna Network Manager will contact you regarding your participation status.

• HMO-based and Medicare Advantage Plans: 1-800-624-0756 
• All other plans: 1-888-MD-Aetna (1-888-632-3862)
• Aetna Behavioral Health: 1-888-632-3862
• Aetna Better Health CT, IL, LA, PA and TX: Go to http://www.aetnabetterhealth.com/Default.aspx and select the appropriate state to obtain contact information
• Aetna Worker's Comp Access: 1-800-238-6206 
• Cofinity: 1-800-831-1166 

Will I be notified if erroneous information is discovered during the credentialing process?  
Yes, the Aetna credentialing department will notify you if erroneous information is discovered during the verification process from any primary source. It is your responsibility to work directly with the reporting entity(ies) to correct the erroneous information.

How can I check on the status of my (re)-credentialing application?
Aetna has a credentialing customer service department that is happy to assist you if you have any questions regarding your credentialing or recredentialing process. You can contact Credentialing Customer Service for Medical Providers: 1-800-353-1232. For Behavioral Health Providers please call 1-800-999-5698.