#1 Aetna Provider Credentialing & Aetna Provider Enrollment in USA- Stars Pro®

Aetna Provider Credentialing Services

Aetna is a renowned insurance provider. Not only does it have a large selection of health care plans, but it also has capable and willing customer service. Aetna provides excellent choices for customers looking to purchase a private medical insurance plan, Medicaid or Medicare plan.

Get Credential Now

Credentialing is the procedure by which we assess whether a provider is eligible to join our network. We consider a variety of factors, including, but not restricted to:

Qualifications include education and training, as well as certifications
Background
Malpractice in personal conduct
Disciplinary actions, as well as the loss or limitation of hospital privileges
Coverage for liability
Licensure

What Differentiate Us From Others?

When a provider first applies, we go through an initial credentialing process, and then we go through a re-credentialing procedure at fixed schedule intervals after that. We adhere to guidelines established by organizations.

The Benefits of Being a Participating Provider

Why should clients have been gone through credentialing? Here are some of the benefits of being an Aetna participating provider:

They are listed in our online provider directory
Our members can locate them, but so can other providers who want to refer to them
Access to our members may result in more patients for them – and more revenue for you
They can gain access to tools on our protected provider website that are only available to our participating providers. These tools can be used to perform tasks such as searching for claims policy information or gaining access to our Provider Payment.

Procedureto Become a Member of theAetna Network?

Way to Get Initiated

Get started

Fill out our online registration for participation form to ask for participation in the Aetna network.

Get contracted

Following that, we will assess the current need to cater to our membership in your area. We don’t want you to be kept waiting, so we’ll let you know whether you’re eligible for membership and initiate the contracting process within a few days.

Get credentialed

Following contracting, and if Credentialing is required, we will obtain your credentialing request to begin the credentialing process. Make sure Aetna is listed as an authorized health plan so that we can access your application.

Get welcomed

Once you have completed credentialing, your agreement will be finalized, and you will receive welcome materials to help you get started.

Review Your Contract

You will receive your contract for review after requesting participation. Please return it to us after you have signed it. We’ll go over your signed contract again once we receive it. Then we’ll send you your final contract.

If you haven’t received your contract yet, make sure you check your spam folder. Just a reminder that this is not the final step. Signing a contract does not imply that you are in-network. Following that, you must complete credentialing.

Our Complete Credentialing Process

To initiate the credentialing process, we will obtain your credentialing application. This step can take months depending on the status of your application and whether you’ve given Aetna permission to access it. If you are already registered ensure that your attestation has not officially ended and that you have given Aetna permission to access your application. This will help to expedite the process. When your credentialing is complete, you will be notified in writing.

It is critical to understand that credentialing and contracting are two distinct processes. Both must be finalized before you can be considered for network membership. After you have completed both, your network official will notify you of the effective date of your participation. If you’re joining an existing team, please check with the group administrator to find out when you’ll be able to start.

FillaCAQH Form Immediately

Here’s what you should do if you have a CAQH-Provider-ID number and are listed with CAQH-ProView:

Double-check that your account is up to date and correct. Your request will not be sent to Aetna until CAQH has confirmed that it is excellent.
Give Aetna care permission to find your personal information [either by selecting global support or manually permitting UnitedHealth care].

Why Are We Using CAQH?

Instead of having to complete individual applications for each health plan, the CAQH application allows providers to be credentialed and re-credentialed using a single standard application. It helps you save time.

How Do You Fill Out The CAQH Form?

Here’s what you should do.

Go to CAQH.org to set up an account and complete an application
If you don’t complete the application or require additional information, someone from CAQH will contact you
Please respond to any queries from CAQH as soon as possible so that you can complete your application
When your request is completed, CAQH will notify you

Re-credentialing

You will be informed for credentialing after three years in the programme to ensure that your certificates remain valid and current. The notification will include your specialty-specific instructions. You may not need to take any action due to re-credentialing if your application is current and on CAQH ProView-TM. You can make changes to your services or service regions at any time using CAQH ProView.

Your provider’s re-credentialing form will be completed within five business days once Aetna receives all essential relevant papers. Inquire about the status of your credential application by sending an email to [email protected] Please include the care provider’s full name, tax ID, and National Provider Identifier (NPI).

Re-credentialing allows you to update your practice’s location and contact information in the Provider Directory, which patients can view. State and federal regulatory agencies, as well as national accrediting organizations.