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Joining the provider network FAQs

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

Facility

 

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

Facility

 

Medical

 

Dental

 

Behavioral Health

 

Pharmacy

 

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

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.
 

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.

 

Learn more about URAC

 

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.

 

Visit CAQH to learn more

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 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)

 

Provider portal

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Legal notices

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).

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