Facilities who would like to join our network, can fill out an application request form:
Individuals who would like to join our network, can fill out an application request form:
Workers compensation, auto injury, First Health*
Apply to join workers’ compensation network in New York
Subject to state law, Aetna evaluates each provider’s request for participation again the current to service our membership in a specific geographic area.
*Exceptions: To join a workers’ compensation network in Texas, do not apply online. Instead call 1-800-937-6824.
Credentialing is done before a health care professional joins the Aetna network. It is a separate process from network contracting.
Credentialing involves collecting and verifying information about a provider's professional qualifications. This includes, but is not limited to:
During credentialing, we also assess whether each provider meets certain criteria relating to professional competence and conduct.
Learn more about Medical Credentialing Policies (PDF)
Our Credentialing Verification Organization (CVO) meets the National Committee for Quality Assurance standards for health plans.
Learn more about National Committee for Quality Assurance
Our CVO maintains accreditation by URAC by meeting strict quality standards.
Aetna uses CAQH ProView for credentialing and recredentialing activities. CAQH's website provides details on completing the CAQH ProView application and the materials needed to complete your application.
CAQH Preview is an on line data source that we use to credential all health care professionals. Health plans and hospitals obtain application information directly from this database. This eliminates the need for multiple organizations to contact the provider for the same information.
If you have not registered with CAQH, you will receive a registration kit within 10 business days after submitting your Aetna application request form.
Please register, and authorize Aetna to review your information. Then we can obtain your data electronically and begin the credentialing process.
If you have already registered with CAQH or have received registration information from CAQH, no further correspondence will be sent to you. Please ensure that you have granted Aetna authorization to review your information.
We use Medversant / ProviderSource for successfully registered, directly credentialed practitioners in Washington state. When these providers complete an online application in Medversant / ProviderSource, they must designate Aetna as an authorized heath plan.
We will notify you of any information errors. It is your responsibility to work with the reporting entity (or entities) to correct the information.
Our Credentialing Customer Service department is happy to assist you. Please contact us:
Credentialing and contracting are separate processes. Both must be complete before you're considered in network. You'll receive a written notification when your credentialing is complete. Then, your network management contact will help you to complete the contracting process.
Our standard contract generally includes Aetna plans. If you have questions about which plans you accept, please contact your network representative, or call us at one of the numbers below.
Contracts generally renew automatically, and you don't need to do anything. If you want or need changes to your contract, contact your network representative, or call us at one of the numbers below.
If you have questions about your participation, please call us:
• Aetna Medical and Aetna Behavioral Health: 1-888-632-3862 (TTY: 711)
• Aetna Medicare Advantage: 1-800-624-0756 (TTY: 711)
• Dental: 1-800-451-7715 (TTY: 711)
• Pharmacy: 1-800-238-6279 (TTY: 711)
• All other questions: 1-888-632-3862 (TTY: 711)
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
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Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
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Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue?
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The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.
Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.
The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.
Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.
Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law.
