Doctors and other providers can join the Aetna Health Network to provide medical services to a growing number of members. Once accepted as part of the network, a doctor is then a network provider and people with the Aetna plan will prefer to use their services. This is a strong advantage if Aetna has many subscribers in your area.
Aetna is recognized as one of the country’s leaders in health insurance. With millions of members on its medical plan, Aetna still has a strong presence in most states. Use the steps below as a guide to joining an Aetna network.
Step 1: Get a National Provider ID (NPI)
Before applying for Aetna’s network, providers, including physicians, other clinicians, medical practitioners, and certain suppliers, must obtain an NPI.
The National Provider ID or NPI is a unique 10-digit identification number used to replace provider IDs, such as the Provider Unique Identifier (UPIN) in standard HIPAA transactions. Healthcare providers are required by HIPAA regulation to obtain an NPI.
If you do not already have an NPI, apply for one at nppes.cms.hhs.gov or call your NPI Trainer at 1-800-465-3203.
Step 2: Submit an application
Aetna requires any provider that has an interest in joining an Aetna network to apply before joining. The application form is evaluated to determine the need for a participating provider in the geographical location of your medical office. Contact one of the following to submit your request for a doctor and other clinical professionals:
- Fill out the online medical plan application form on the Aetna website
- Contact a dealer at 1-800-353-1232
- The medical unit should contact the Aetna Customer Service Center at 1-888-632-3862.
Make sure you have your tax office tax registration number and your medical license number. If your application is accepted, Aetna will email the delivery agreement for your review. Signature required.
Step 3: Join a CAQH Universal Provider (UPD) Data Source
CAQH UPD is an online tool designed to simplify the process of gathering information required by health plans for provider certification and more. This process prevents providers from submitting the same information to multiple health insurance plans. Members can supplement and submit their information on all health plans for free.
- Obtain a CAQH Provider ID by calling the CAQH Support Office at (888) 599-1771 or emailing firstname.lastname@example.org
- Login to upd.caqh.org/oas/
- Follow the instructions to complete and activate the registration
Step 4: Complete the application
The application process can be completed entirely electronically. Once the application is completed and certified, you will need to authorize Aetna to access your registration application and other information. The whole process should not take more than two hours to complete. The section is also designed to store your information if you need to complete the application in multiple sessions.
The CAQH support office is available to help you if you need help during the process.
Step 5: Gather all the supporting documentation
Any relevant documentation must fax to CAQH at (866) 293-0414. You will need:
- Curriculum vitae
- Medical leave
- DEA Certificate
- CDS Certificate
- IRS Form W-9
- Poor insurance sheet insurance
- Summary of all pending or settled cases of misconduct
Aetna has a unique Credentialing process. The Aetna CVO (Credit Verification Agency) evaluates each applicant’s qualifications before accepting a provider to join an Aetna network. In addition to the information requested by CAQH, Aetna will also examine professional competence and conduct.
Other relevant information
- The whole process can take up to three to six months
- The written notice will sent to the provider as soon as a decision is make
- For more information about your Aetna Medical Office, visit www.aetna.com and www.caqh.org.