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    • Request to join the Aetna® network

    Welcome

    Request to join Aetna network

    Ready to Join the Aetna Network?

    Here's how it works:

     

    Step 1

    First, you can request participation in the Aetna network by completing our online request for participation form.

     

    Step 2

    Next, we’ll evaluate the current need to service our membership in your area.  We don’t want you to wait, so we’ll make sure to let you know within 45 days whether you’re eligible for participation and begin the contracting process.

     

    Step 3

    After contracting, and if Credentialing applies,  we'll get your credentialing application from the Council for Affordable Quality Healthcare (CAQH) ProView to begin the credentialing process. Make sure you designate Aetna as an authorized health plan so we can access your application.

     

    Step 4

    When you complete credentialing, your contract will be finalized and you'll receive welcome materials to get up and running.

     

    Ready to get started?

    Choose the category on the left that applies to you. Then follow the prompts to complete your request.

    Medical

    Request to join Aetna network

    Medical Request for Participation

     

    Please complete this form if you’re interested in joining Aetna's network and you are a medical health care professional, physician or non-physician.

     

    Helpful Tips to consider before completing request for participation:

     

    • If you are a midlevel provider complete the “medical request for participation” form.   Under the “specialty” question on the form, please refer to the instructions for non-physicians to select their “provider type” from the pull down menu e.g. Midwife, Nurse Practitioner, Physician Assistant.  
    • If you have multiple Tax ID’s, you only need to complete this form once for your primary service location to initiate your contracting and credentialing process.
    • If you’re already in our network, you can’t use this form to update your Tax ID. In-Network providers can update their Tax ID by clicking on Contact and then selecting Practice changes/Provider termination from the list.
    • If you’re a Behavioral Health professional, including those joining a medical group, you should click on the Behavioral Health link and complete the Behavioral Health request for participation form.
    • If you’re a hospital based provider joining an already contracted group, you don’t need to complete the application independently. 

     

    If you need more information about our application and credentialing process, use the link below. You’ll also find information on Council for Affordable Quality Healthcare's (CAQH) ProView® and Medversant/ProviderSource™.

     

    Please ensure that your CAQH ProView or Medversant/ProviderSource™ applications are complete to avoid delays in the Credentialing process.

     

    Information about our application and credentialing process >

     

    As a practitioner, you have the right to correct any information obtained during the credentialing process by working directly with the reporting entities.

     

    Dental

    Request to join Aetna network

    Dental Request for Participation

     

    Dentist - Dental Maintenance Organization (DMO®) and managed dental products and/or Preferred Provider Organization (PPO) plans* application request.

                                     

    Please complete this form below to get an application to join Aetna's Network.

     

    *In Texas, the Preferred Provider Organization (PPO) is known as the Participating Dental Network (PDN).

    Behavioral Health

    Request to join Aetna network

    Behavioral Health Request

    for Participation

     

    Helpful Tips to consider before completing request for participation:

     

    • If you’re a Behavioral Health professional, including those joining a medical group, you should complete this Behavioral Health Request for Participation form.
    • If you need more information about our application and credentialing process, use the link below. You will also find the information on Council for Affordable Quality Healthcare (CAQH) ProView® and Medversant/ProviderSource™.

    Please ensure that your CAQH ProView or Medversant/ProviderSource™ applications are complete to avoid delays in the Credentialing process.

     

    Information about our application and credentialing process >

     

    As a practitioner, you have the right to correct any information obtained during the credentialing process by working directly with the reporting entities. 

     

    Facility

    Request to join Aetna network

    Facility Request for Participation

     

     

    Want to contract with us? Complete this form if you are a hospital, facility, or ancillary provider only.

     

    Individual physicians/providers (type 1) or physician/provider groups should complete an NPI type 1 individual application.   

     

    Note: A separate application needs to be submitted for each physician/provider in your group. 

     

    Complete an NPI type1 individual application >

     

    Questions about individual physician/provider or physician/provider groups application process?

     

    Read our joining Network FAQs >

     

    Once you complete the application, we will 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 formal credentialing process.
    • If the panel is not open or we do not intend to pursue a contract, you will be notified by a 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. 

     

    *Do you confirm this is a type 2 facility NPI?

    If this is a type 1 NPI or physician/provider group, you must complete a type 1 application request form. 

    Other

    Request to join Aetna network

    Other networks you can join


    Pharmacy and Medicare Part D.

     

    We welcome pharmacies to join our retail networks.

    Request for Participation
     

    Other Networks

     

    You can also join Networks for Coventry Workers' Compensation in NY and First Health.

    Request for Participation