How to Become a Provider With Aetna

by Francine Richards; Updated September 26, 2017
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Since Aetna is one of the largest health insurers in the U.S., as of 2010, joining the Aetna network is a wise decision for a provider. Network benefits include referrals, easy claims submission, quick claims reimbursement, and access to online tools such as eligibility verification, claims information, precertification requests and industry articles. Aetna reviews each network provider application and completes a thorough credentialing review of qualifications, licensure, certification, academic qualifications and litigation history. Provider location and specialty are other factors that determine network admittance.

Step 1

Visit Aetna’s website and access the “Medical Plans Application Request Form” to complete the application online. You may also call 1-800-353-1232 to request a hard copy application to mail back to Aetna. Behavioral health providers should complete the online “Health Professionals Behavioral Health Application Request Form” or call 1-800-999-5698 for a hard copy application.

Step 2

Complete the application with your name, birthdate, tax identification number, clinical specialty, state license information, practice address, national provider identifier, hospital affiliations and other relevant information.

Step 3

Click “I agree to the Email Acknowledgement” and “Submit.” Your completed application will go to the Aetna provider network department which begins the review.

Step 4

Go to the Council for Affordable Quality Healthcare (CAQH) website and register with its Universal Provider Data Source. Give Aetna authorization to obtain your credentialing information. If you have already registered with CAQH prior to completing the Aetna application, make sure you granted Aetna access to your information.

Step 5

Wait for Aetna to review your application and check your credentials. Upon completion, Aetna will send you a letter pertaining to your admittance or denial into the Aetna network. Sign and send back any agreements if required. Contact Aetna’s Credentialing Customer Service at 1-800-353-1232 (medical providers) or 1-800-999-5698 (behavioral health providers) with any network questions.

About the Author

Francine Richards is a licensed multi-state insurance agent with years of human resources and insurance industry experience. Her work has appeared on Blue Cross Blue Shield websites and newsletters, the Houston Chronicle and The Nest. Richards holds a Bachelor of Arts in communications from the University of Maryland.

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