Aetna credentialing: how to join the Aetna network

Which Aetna route is yours

The Provider Onboarding Center also offers First Health, a separate network that Aetna owns. For an Aetna medical or behavioral health contract, choose Aetna. Aetna says physicians in Arkansas, and practitioners in the Allina Health | Aetna network in Minnesota, have their credentialing data gathered by different vendors, so expect a slightly different path there.

Aetna is usually one of several insurers a practice joins, alongside your state's Blue Cross Blue Shield plan and UnitedHealthcare. Our guide on how to get credentialed with insurance companies covers the full order.

Before you start

• NPI, and group NPI if you bill as a practice
• Tax ID and a W-9 that match your request
• CAQH ID, with the profile attested in the last 120 days
• Aetna authorized to view your CAQH profile
• State license, DEA if you prescribe, and malpractice certificate
• Work history by month and year, with gaps explained

Aetna uses CAQH ProView for both credentialing and recredentialing, and pulls your application data from it electronically. A complete, attested profile with Aetna authorized is the single biggest thing you control. Our CAQH guide walks through setup, authorization and re-attestation.

Joining Aetna, step by step

Step 1: Know that Aetna checks the network first

Aetna says it reviews each request to join against the providers it already has in that area, as state law allows. If the network is full for your specialty where you practice, Aetna can decline the request. That's a network decision, not a judgment of your credentials, and it can change, so it's worth asking again later or applying for a different location.

Step 2: Submit a request for participation

In the Provider Onboarding Center, choose Join the network, select Aetna, and complete the request for participation. You can save a request and finish it later. Use the Tax ID, group and practice locations you'll actually bill under, written exactly as they appear on your NPI record and W-9.

Step 3: Register with CAQH or authorize Aetna

If you aren't registered with CAQH yet, Aetna says a registration kit arrives within 10 business days of your request. Register, complete every section, attest, and authorize Aetna. If you're already registered, Aetna won't send anything separate: just confirm Aetna is authorized and your attestation is current.

Step 4: Credentialing review

Aetna's credentialing department verifies your information with primary sources: your state licensing board, your training and board certification, your DEA or state controlled substance registration, malpractice coverage and claims history, Medicare and Medicaid sanctions, the National Practitioner Data Bank, and your work history. A committee of community practitioners makes the decision. If Aetna finds an error, it tells you, and you fix it with whoever reported it, such as the licensing board.

Step 5: Contracting and your effective date

Credentialing and contracting are separate at Aetna, and you need both to be in-network. When credentialing is complete you get a written notice, and a network management contact then works through the contract with you. Check which plans and locations it covers before you sign, and don't bill Aetna members as in-network until you have your effective date in writing.

Commercial, Medicare Advantage and Medicaid

Aetna says its standard contract generally includes Aetna plans, but ask your network representative which ones your agreement covers, especially Medicare Advantage, which has its own provider line at 1-800-624-0756. Aetna's Medicaid plans, under the Aetna Better Health name, contract separately in each state. Traditional Medicare is separate from all of these, and you join it through PECOS.

How long Aetna credentialing takes

Aetna doesn't publish a standard turnaround for medical and behavioral health credentialing. As a planning range, allow 60 to 120 days from a complete request and an authorized CAQH profile. Requests slow down when CAQH isn't attested or authorized, when the Tax ID or group details don't match, or when the network in your area is full for your specialty.

To check your status, providers in Missouri can use Aetna's online status request form. Everywhere else, call 1-800-353-1232 for medical and behavioral health, or 1-800-451-7715 for dental. Have your NPI and Tax ID ready.

Aetna Dental is a separate application

Dentists apply on Aetna Dental's site by choosing their state, then either uploading their CAQH application, filling in Aetna's standard application, or using a state application where one is required. Aetna says a network representative contacts you within 30 days of your application to start contracting, then credentialing begins. When it's complete you get a welcome letter with your effective date, and you can submit claims in-network from that date.

After you're in: recredentialing

Aetna's credentialing follows NCQA standards, which require recredentialing at least every three years, and Aetna pulls that data from CAQH. Keep your attestation current every 120 days and update CAQH whenever your license, DEA or malpractice policy renews, so recredentialing can finish without a gap. Aetna says contracts generally renew automatically. Our recredentialing guide covers every insurer's cycle, plus Medicare and Medicaid.

Common mistakes

• CAQH not authorized for Aetna, so Aetna can't pull your data and the request waits.
• Choosing First Health in the Provider Onboarding Center when you meant to join Aetna.
• Wrong Tax ID: applying as an individual when you'll bill under a group, or the reverse.
• Assuming credentialing approval means you're in-network. The contract and effective date come after.
• Expecting one contract to cover Aetna Better Health, which contracts separately in each state.

Common questions