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.
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:
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:
Way to Get Initiated
Fill out our online registration for participation form to ask for participation in the Aetna network.
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.
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.
Once you have completed credentialing, your agreement will be finalized, and you will receive welcome materials to help you get started.
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.
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.
Here’s what you should do if you have a CAQH-Provider-ID number and are listed with CAQH-ProView:
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.
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.