How Providers Can Participate in an Aetna Network

How to Apply and Be Credentialed as an Aetna Network Provider

Physicians and other providers can become participants in the Aetna healthcare network to provide medical services to their growing numbers of members. Once accepted as part of the network, a physician then is an in-network provider and people with the Aetna plan will preferentially use their services. This is a strong advantage if Aetna has many subscribers in your area.

Aetna recognizes itself as one of the nation's leaders in health insurance. With millions of members in its medical plan, Aetna's continues to have a strong presence in most states. Use the following steps as a guide to becoming a participant in an Aetna Network.

Step 1: Obtain a National Provider Identifier (NPI)

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Prior to applying for participation in Aetna's network, providers including physicians, other clinical professionals, medical office practices and certain suppliers must obtain an NPI.

The National Provider Identifier or NPI is a 10 digit unique identification number used to take the place of provider identifiers such as a Unique Provider Identification number (UPIN) in HIPAA standard transactions. Health care providers are required by regulation of HIPAA to obtain an NPI.

If you do not already have an NPI, apply for one at nppes.cms.hhs.gov or call the NPI Enumerator at 1-800-465-3203.

Step 2: Submit a Request for Participation

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Aetna requires any provider that has an interest in participating in an Aetna network to submit a request for participation prior to submitting an application. The request for participation is assessed to determine a need for a participating provider within the geographical location of your medical office. Contact one of the following to submit your request for physician and other clinical professionals:

  1. Complete the online Medical Plans Application Request form on Aetna's website
  2. Contact a representative at 1-800-353-1232
  3. The medical facility must contact Aetna Provider Service Center at 1-888-632-3862.

Be sure to have your medical office's Tax ID and medical license number on hand. If your request is accepted, Aetna will send your provider agreement via email for your review. A signature is required.

Step 3: Join CAQH Universal Provider Datasource (UPD)

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CAQH UPD is an online tool designed to simplify the process of gathering information required by health plans for provider credentialing and much more. This process prevents providers from having to submit the same information to multiple health insurance plans. Members can complete and submit their information to all health plans for free.

  • Obtain a CAQH Provider ID by calling the CAQH Support Desk at (888) 599-1771 or email caqh.updhelp@acsgs.com
  • Login at upd.caqh.org/oas/
  • Follow instructions to complete and activate registration

Step 4: Complete the Application

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The application process can be completed entirely online. Once the application is completed and attested, you will need to authorize Aetna to gain access to your enrollment application and other information. The entire process should take no longer than two hours to complete. The module is also designed to save your information if you need to complete the application in multiple sessions.

The CAQH support desk is available to assist you if you should need help during the process.

Step 5: Gather all Supporting Documentation

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Any applicable supporting documentation must be faxed to CAQH at (866) 293-0414. You will need:

  • Curriculum Vitae
  • Medical license
  • DEA certificate
  • CDS certificate
  • IRS Form W-9
  • Malpractice insurance face sheet
  • Summary of any pending or settled malpractice cases

Aetna has a unique Credentialing process. Aetna's CVO (Credentialing Verification Organization) evaluates each applicant's qualifications before a provider can be accepted for participation in an Aetna network. In addition to the information requested by CAQH, Aetna will also review professional competence and conduct.

Other Pertinent Information

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  • The entire process may take up to three to six months
  • Written notification will be sent to the provider once a decision has been made
  • For more information about your medical office becoming an Aetna participating provider visit www.aetna.com and www.caqh.org.

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