Aetna Provider Credentialing Service
Credentialing is a process that evaluates a doctor’s or health practitioner’s qualifications and work history. A review of each doctor and health practitioner’s completed education, training, residency, and licensing is part of this procedure. It also contains any certificates issued by a board in each of their particular areas. Health practitioners who provide care to Aetna members are evaluated through the Aetna credentialing process. Before allowing them to join our network, we go through this procedure. We also conduct regular checks on their credentials. We adhere to the criteria established by states, regulatory entities, and accrediting bodies such as the National Committee for Quality Assurance (NCQA).
Why House of Outsourcing?
We believe that providing care should be done in a collaborative manner. To achieve the best outcomes for our members, we collaborate with providers who provide high-quality, cost-effective care. Members are encouraged to take control of their health through our programs. Members create health goals as part of our care management program. Our team of case managers and clinicians collaborate with the member to reach their objectives. The member is not charged for this benefit.
Our Specialist Will Get You Enrolled With Aetna
We put a premium on operational excellence at Aetna Tricare health provider. For the benefit and value of all of our partners, we seek to minimize redundancy and streamline operations. Some of the reasons why providers have opted to work with us in managed health care are listed below:
- Gain access to continuing assistance and learning opportunities
- Claims are resolved quickly and efficiently, and you are compensated fairly
- Have access to cutting-edge technologies that can assist you in providing better patient care
How to join our network?
To get started, fill out the participation request form found here.
We’ll then start the contracting process. After you submit your Request for Participation form, an Aetna Network representative will contact you within 30 days.
We will get your Council for Affordable Quality Healthcare Application (CAQH) around 20 days after we receive your contract, if applicable. To allow us to access your application, make sure your CAQH Proview Application is “Complete” and Aetna has been recognized as an authorized health plan. The credentialing procedure will take around 45 days once we have received your completed CAQH Proview application.
Your contract will be finalized once credentialing is completed, and welcoming materials will be delivered to assist you in getting started with Aetna!
If you join the Aetna network, you will be accredited according to the following Aetna standards. Aetna will maintain a network that is certified and re-credentialed in accordance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and URAC accrediting organizations, as well as state and federal standards. In its credentialing procedure and safe primary source verification, Aetna will evaluate the following factors:
- Certification and/or licensure
- Certifications from the Board of Directors (when applicable)
- Professional liability insurance that is currently in effect
- Disciplinary history or disciplinary procedures taken against you as a result of your licensure
- Examining the history of malpractice insurance claims
- Both mental and physical wellness is important
- Verification of professional education and training
- Work experience
Re-credentialing entails re-verification as well as the identification of variances between practitioners or HDOs:
- Health status
- The performance data (including, but not limited to, negligence experience, hospital right, or other actions) that may indicate on the Practitioner’s or HDO’s professional conduct and support
Aetna Enrollment Application
The following are the essential processes to submitting an application for participation:
Here is where you can submit an application.
- If we don’t need a provider in that specialty/service location, we’ll send them a letter. If we can’t credential the provider, we’ll send them a letter.
- We’ll acquire your client’s application from the Council for Affordable Quality Healthcare (CAQH) website if they’re eligible and registered.
- Providers that have registered with CAQH can fill out applications on their own website; just make sure your client has given us permission to access their data.
- If your client isn’t already a CAQH member, we’ll assign them a CAQH ID and send them a new provider registration kit.
- We’ll begin working on the application as soon as we receive it; it usually takes 45 days unless state regulations require us to complete it sooner.
- Someone from our Network Management department will contact them once the provider has been approved.
Why Are We Using CAQH?
Instead of 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.
The Aetna credentialing and Performance Committee (CPC) has authority for making final determinations for those individual practitioners being considered for exceptions to Aetna’s established requirements for professional competence and conduct.
Aetna Credentialing Phone number
If you have any contract questions, please call this number.
Aetna Provider Enrollment Status
To validate eligibility status, benefits, and other questions, utilize the above-mentioned email address and phone number.