Aetna Provider Guide
Complete credentialing, billing, authorization, and denial management guide for Aetna
Avg. Credentialing
90-120 Days
Timely Filing
180 Days
Appeal Window
180 Days
Portal
NaviNet
Credentialing & Enrollment
Getting Started with Aetna Credentialing
Complete guide to joining the Aetna provider network
Application Process
- Complete CAQH profile (if not already done)
- Submit initial credentialing application via Aetna provider portal or CAQH
- Provide all required documentation (licenses, certifications, malpractice, etc.)
- Complete site visit if required
- Await committee approval (typically 90-120 days)
Required Documents
- • Current medical license (all states)
- • DEA certificate (if applicable)
- • Board certification
- • Malpractice insurance (minimum $1M/$3M)
- • W-9 or tax documentation
- • NPI (Type 1 and Type 2)
Timeline Tips
Aetna credentialing typically takes 90-120 days. Incomplete applications can delay the process by 30-60 days. Submit all documents upfront and respond quickly to any requests.
Claims Submission
Clean Claim Checklist
Ensure these elements are included to avoid rejections
Required Fields
- ✓ Correct member ID and group number
- ✓ Valid CPT/HCPCS codes
- ✓ Appropriate diagnosis codes (ICD-10)
- ✓ Date of service
- ✓ Place of service code
- ✓ Rendering provider NPI
- ✓ Billing provider NPI and TIN
Common Mistakes
- ✗ Missing modifiers
- ✗ Incorrect units of service
- ✗ Mismatched dates
- ✗ Missing authorization numbers
- ✗ Wrong rendering provider
- ✗ Outdated member information
Common Denials & How to Fix Them
CO-197: Precertification/authorization absentHigh Frequency
Why This Happens
Service required prior authorization but none was obtained
How to Fix It
Submit retroactive authorization request with medical records. If approved, resubmit claim. If denied, patient may be responsible.
Prevention
Always verify authorization requirements before service
CO-50: Non-covered servicesCommon
Why This Happens
Service not covered under patient's plan or deemed experimental
How to Fix It
Review plan documents. If service should be covered, submit appeal with medical necessity documentation. Otherwise, bill patient.
CO-16: Missing or incomplete informationCommon
Why This Happens
Claim missing required data fields
How to Fix It
Identify missing information from remittance advice and resubmit corrected claim
Important Contacts
Provider Services
General Provider Line
1-800-624-0756
Prior Authorization
1-800-245-1206
Claims Status
1-888-632-3862
Credentialing
1-888-632-3862