Request to join the 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 for Participation

Please complete this form if you’re interested in joining Aetna's network and you meet any of these criteria:

·         I am a physician

·         I am a non-physician health care professional who is not employed by an Aetna contracted provider (physician group, hospital, etc.). I practice independently and I want to contract with Aetna.

·         I am a non-physician health care professional who wants to be available for member selection as a primary care provider (PCP), and my state regulations allow me to serve as a PCP. I may or may not be employed by an Aetna contracted provider.

If none of these criteria apply to you, click on Mid-level Practitioner for more information.
 

Helpful Tips to consider before completing request for participation:

·         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.

Mid-Level Request for

Participation

Please complete this form if you’re interested in joining Aetna's network and you meet both of these criteria: 

• I am a Nurse Practitioner, Registered Nurse Anesthetist, Physician Assistant, Clinical Nurse Specialist or Certified Nurse who is employed by an Aetna contracted provider (physician group, hospital, etc.) .
• I will not be practicing as a Primary Care Provider (PCP).

If the above criteria does not apply to you, please use the Medical link to the left to review medical criteria to see if the Medical Request for Participation applies to you.  If additional assistance is needed, please call 1-800-353-1232.

Helpful Tips to consider before completing request for participation:

• Completing this form will add your information to our provider database. You should check DocFind to verify your listing within 45 days of submitting this form.

• This process does not require credentialing and welcome letters will not be sent.

• Don’t complete this form if you need to submit more than 10 nurse practitioners, nurse midwives, physician assistants or clinical nurse specialists. You should contact your Aetna network representative for assistance. 

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

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. 

      Other networks you can join

           Pharmacy and Medicare Part D.

           We welcome pharmacies to join our retail networks.

           Other Networks

            You can also join networks for Conventry Workers'  
            Compensation, Conventry Auto Injury and First Health.