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Health care professionals: Joining the network FAQs

How do I apply to join an Aetna network?
Facilities who would like to join our network should contact their network representative for more information.

Individuals who would like to join our network can fill out an application request form:

Medical
Dental (excludes oral/maxillofacial surgeons)
Behavioral health 
Pharmacy

Subject to state law, Aetna evaluates each provider’s request for participation against the current need to service our membership in a specific geographic area.

What is credentialing? 
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:

  • Relevant training
  • Licensure
  • Certification and/or registration to practice in a health care field
  • Academic background

During credentialing, we also assess whether each provider meets certain criteria relating to professional competence and conduct. 

Our Credentialing Verification Organization (CVO) meets the National Committee for Quality Assurance standards for health plans. Our CVO maintains accreditation by URAC by meeting strict quality standards.

URAC logo URAC logo
NCQA Logo NCQA Logo

Why do I need to register with CAQH?
CAQH Proview is an online 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 I am already registered with CAQH, what are my next steps?
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.

What is ProviderSource? 
We use ProviderSource for successfully registered, directly credentialed practitioners in Washington state. When these providers complete an online application in ProviderSource, they must designate Aetna as an authorized heath plan.

What if errors are discovered during the credentialing process? 
We will notify you of any information errors.  It is your responsibility to work with the reporting entity (or entities) to correct the information.

How can I check on the status of my credentialing or re-credentialing?
Our Credentialing Customer Service department is happy to assist you. Please contact us:

  • Medical and Behavioral Health: 1-800-353-1232
  • Dental: 1-800-451-7715

After credentialing is complete, can I begin seeing Aetna members? 
Credentialing and contracting are separate processes, and both must be complete before you can join our network. You will receive written notification when your credentialing is complete. Then, your network management contact will help you to begin the contracting process.

I already have a contract with Aetna. What if I want to contract with other Aetna plans or with Coventry plans?
Our standard contract generally includes Aetna and Coventry plans. If you have questions about which plans you accept, please contact your network representative, or call us at one of the numbers below.

I am already contracted with Aetna. How do I renew my contract?
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.

I still have questions. 
If you have questions about your participation, please call us:

  • Aetna Medical and Aetna Behavioral Health: 1-888-632-3862
  • Aetna Medicare Advantage: 1-800-624-0756
  • Coventry: 1-800-937-6824
  • Dental: 1-800-451-7715
  • Pharmacy: 1-800-238-6279
  • Workers’ Compensation: 1-800-238-6206
  • All other questions: 1-888-632-3862

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