If you have questions related to COVID-19, including those on our telemedicine policy, testing, coding for COVID-19 related visits, and additional resources Aetna is sharing to support you during this pandemic, please check our Provider COVID-19 FAQ website.
To help us direct your question or comment to the correct area, please select a category below.
It's easy to update a provider address, phone number, fax number, email address or initiate an out-of-state move or a change in provider group.
The Provider Service Center helps with contracting, patient services, precertification and many other questions.
Claims - if you have questions about claims, contact the Provider Service Center (see list below)
By using our provider portal on Availity, you can handle tasks for your patients with Aetna plans, including:
Relocating, retiring, job changes
If you’re retiring, moving out of state, or changing provider groups, use this form to notify us. We’ll need to terminate your existing agreement with us. If you’re moving or changing jobs, you can sign a new agreement for your new practice or location.
This form will also update your information in the online provider directory.
If ONE of the following criteria applies to you, please request a medical application form using the link below:
Request a medical application - credentialing is required
Note: If you are a hospital based provider seeking to join an already contracted group, you do not need to complete the application independently.
Independent retail pharmacies
Independent retail pharmacies can fill out the form at the link below. Please fill in all fields.
Independent non-retail pharmacies
Independent non-retail pharmacies - such as long-term care facilities, home infusion pharmacies, and mail order pharmacies - can call one of the phone numbers below to request participation:
CVS Health - 1-480-391-4623
Chain or Pharmacy Services Administrative Organization (PSAO) pharmacies
Chain or PSAO pharmacies can request to participate in our Part D retail pharmacy network by emailing us this information:
To request participation in Coventry Workers' Compensation, Coventry Auto Injury, or First Health networks, follow the links below.
Exception: For workers' compensation network in Texas, do not apply online; instead, call 1-800-937-6824.
Apply to join the workers' compensation network in New York
Have questions about our products, policies and services? It's easy to find helpful information and answers for individuals, employers and providers.
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).
Health benefits and health insurance plans contain exclusions and limitations.
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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.
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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.
