Skip to main content

Join the Aetna network: Facility request form

Are you a facility, and want to participate with us?

We’re here to help. Note: This form is only for hospitals, facilities, or ancillary providers. Once you complete the form, we’ll review your request and make a decision within 60 days. 


  •  If the panel is open and we intend to pursue a contract: An Aetna Network Manager will contact you to start the credentialing process.
  • If the panel isn’t open or we don’t intend to pursue a contract. We’ll send you an update by letter or email that the request has been denied.
  • If this is an NPI type 1 physician/provider group request, we will automatically deny the application and you will be notified of this action by letter or email.

To get started, complete the facility request form

Are you an individual physician/provider or physician/provider group, and want to participate with us?

You would need to complete a different application (NPI type 1). Otherwise, your request would be denied. So, let’s get you to the right place.

Complete individual provider application

Questions? See our joining the network FAQs

Are you looking to participate in our Medicaid products?

To learn more, visit For all other products, you can continue to the form below.

Important: This form is for new facility requests. Please submit one application per state. All fields marked with an asterisk (*) are required.


If you’ve submitted a request in the last 12 months and have received a response from Aetna Health, Inc., we ask that you do not submit another request for at least one year. This encompasses all states. Unfortunately, we cannot respond to additional requests if we’ve already responded in the last 12 months. We’ll keep this request on file for one year from the date we received it, and we’ll contact you if there are future opportunities for expansion.

In August 2020, Mitchell|Genex acquired Coventry Workers’ Comp Services. The acquisition adds Coventry’s preferred provider network to the Mitchell|Genex care and cost containment offerings for the workers’ compensation and auto industry. To learn more about participating in these product offerings, send us an email

*PRODUCT OR PLAN (Select all that apply)

Facility information & contact details

Facility Doing Business As (DBA) name
A 9-digit tax identification number is required. Please do not include spaces or dashes.
A 10-digit National Provider Identifier (NPI) number is required. Please do not include spaces or dashes.
Include official primary service address of facility (no post office box info, please). Also, avoid using abbreviations (i.e. "Rd" should be entered as "Road").
List counties as applicable (e.g., Delaware County, Montgomery County).

*Facility phone number

*Facility fax number

Formatted as

Facility primary contact information

*Phone number (10 digits)

*Fax number (10 digits)

Formatted as

Medicare information

Enter up to 10 digits
MEDICARE TYPE (select all that apply)

Also of interest: