How to Join the Aetna Network
Complete step-by-step guide to Aetna credentialing, requirements, and timelines for healthcare providers
Overview
Joining the Aetna provider network opens your practice to millions of potential patients. Aetna is one of the largest health insurance companies in the United States, serving both commercial and Medicare Advantage populations.
This comprehensive guide walks you through the entire credentialing process, from initial application to receiving your first payments.
Step 1: Determine Your Eligibility
Before applying, ensure you meet Aetna's basic requirements:
- Current, unrestricted license to practice in your state
- Board certification in your specialty (strongly preferred)
- Malpractice insurance with minimum $1M/$3M coverage
- DEA registration (if prescribing controlled substances)
- Clean professional history (no sanctions or disciplinary actions)
- National Provider Identifier (NPI)
Important Note
Aetna networks vary by state and plan type. You may need to apply separately for different Aetna subsidiaries (e.g., Aetna Better Health for Medicaid). Check which specific networks you want to join.
Step 2: Complete Your CAQH Profile
Aetna uses the Council for Affordable Quality Healthcare (CAQH) ProView for primary source verification.
Create/Update CAQH Profile
Visit caqh.org and create an account if you don't have one. Complete all sections thoroughly.
Upload All Documentation
Include licenses, certifications, malpractice insurance, DEA, and W-9.
Attest and Submit
Review carefully and attest to the accuracy of all information.
Re-attest Every 120 Days
Keep your profile current to avoid delays in credentialing and re-credentialing.
Step 3: Submit Aetna Application
Once your CAQH profile is complete:
Online Submission (Preferred)
- Visit Aetna's provider relations website
- Complete the online network participation application
- Authorize Aetna to access your CAQH profile
- Submit any Aetna-specific supplemental forms
Required Information
- Practice name and Tax ID (TIN)
- NPI (both Type 1 and Type 2 if applicable)
- Office locations and hours
- Hospital affiliations
- Specialty and sub-specialties
- Age groups treated (pediatric, adult, geriatric)
- Languages spoken
- Whether you're accepting new patients
Step 4: The Credentialing Process
After submission, Aetna begins the credentialing verification process:
What Aetna Verifies
- Medical license (primary source)
- DEA registration
- Board certification status
- Education and training
- Work history
- Malpractice insurance
- NPDB and sanctions check
Timeline
Initial Review: 2-4 weeks
Aetna reviews your application for completeness
Primary Verification: 4-8 weeks
Verification of credentials with issuing sources
Committee Review: 2-4 weeks
Credentialing committee evaluates application
Total: 90-120 days
Average time from submission to approval
Common Delays and How to Avoid Them
Incomplete CAQH Profile (30-60 day delay)
Solution: Complete all sections before submitting to Aetna
Expired Documents (14-30 day delay)
Solution: Ensure licenses and insurance are current with at least 6 months validity
Unreturned Verification Requests (21-45 day delay)
Solution: Respond immediately to any requests from Aetna
Site Visit Requirements (30+ day delay)
Solution: Schedule site visits promptly if required
Step 5: Contract Execution
Once approved by the credentialing committee:
- Receive Contract: Aetna will send you a provider agreement to review
- Review Terms: Pay special attention to reimbursement rates, termination clauses, and administrative requirements
- Negotiate (if possible): Some terms may be negotiable, especially for high-demand specialties
- Sign and Return: Execute the contract and return all required forms
- Effective Date: Note your effective date for billing purposes
Step 6: Set Up Billing and Access
Register for Provider Portal
Sign up for NaviNet or Availity to check eligibility, submit authorizations, and track claims
Configure Your Practice Management System
Add Aetna payer information, including payer ID, claim submission address, and contact numbers
Train Your Staff
Educate billing and front office staff on Aetna's requirements, authorization process, and common issues
Submit Test Claims
Consider submitting a few test claims to ensure your billing process works correctly
After Credentialing: Staying In-Network
- Re-credentialing: Aetna re-credentials providers every 3 years. Keep your CAQH profile updated.
- Report Changes Immediately: Notify Aetna of any changes to licenses, locations, phone numbers, or malpractice coverage
- Monitor Compliance: Stay current on Aetna's policies, clinical practice guidelines, and administrative requirements
- Quality Metrics: Be aware that Aetna tracks quality and patient satisfaction metrics