Paul Sanchez
Aetna is a leading provider of health insurance in the United States, offering coverage for medical, dental, pharmaceutical, and behavioural health services, as well as long-term care and disability plans. With millions of users, many physicians and medical practitioners want to become participants in the Aetna healthcare network. To become an in-network provider, medical services need to apply for Aetna Insurance Provider Credentialing, which can be a long and complicated process. This process includes obtaining an NPI, completing the registration process with CAQH, and submitting various supporting documents. Aetna's network includes other insurance companies, such as Meritain and Coventry, and offers health insurance plans in various states, including California, New Jersey, Virginia, Florida, Georgia, Pennsylvania, and Texas. Health insurance plans are also available in Nevada and other states.
| Characteristics | Values |
|---|---|
| Aetna's subsidiary companies | CVS Pharmacy, MinuteClinic, LLC, Aetna Health of California Inc., Aetna Health Inc. (Florida), Aetna Health Inc. (Georgia), Aetna Life Insurance Company, Aetna Health of Utah Inc., Aetna Health Inc. (Pennsylvania), Aetna Health Inc. (Texas) |
| Aetna's services | Medical, dental, pharmaceutical, behavioral health services, long-term care, disability plans, Medicare |
| Aetna's plans | Individual and family plans, ACA plans, Medicaid |
| Aetna's application process | Online request for participation form, evaluation of need to service members in the location, credentialing application from CAQH ProView |
| Aetna's application requirements | NPI, medical office’s tax ID, medical license number, CV, DEA certificate, CDC Certificate, IRS Form W-9, Malpractice Insurance face sheet |
| Aetna's application duration | 90-120 days |
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What You'll Learn
Application process for healthcare providers
To become a participant in the Aetna healthcare network, healthcare services need to apply for Aetna Insurance Provider Credentialing. The entire process of applying to get into any insurance provider's network can be long and complicated.
Firstly, healthcare providers must obtain a National Provider Identifier (NPI), a ten-digit unique identification number used to replace provider identifiers in HIPAA standard transactions. This should be obtained before applying to get into the Aetna network.
Next, medical providers with an interest in participating in the Aetna network must submit a request for participation before filling up the application. This request is then assessed by Aetna to determine a need for the participating provider in the area of their practice. The request can be submitted online on Aetna's website or by contacting the Aetna provider service center directly.
Once the request is approved, the provider must then complete the application. Aetna will review the request and make a decision within 60 days. If the panel is open and Aetna intends to pursue a contract, an Aetna Network Manager will contact the applicant to start the formal credentialing process. If the panel is not open or Aetna does not intend to pursue a contract, the applicant will be notified by letter or email that the request has been denied.
The CAQH Unique Provider Data Source is an online tool that gathers the information required by health plans to obtain provider credentialing. Medical practitioners must log in to the CAQH page to complete and activate the registration process. Once the NPI is obtained and the registration process with CAQH is complete, the applicant must authorize Aetna to access their enrollment application and other information.
All supporting documents required for assessment should be submitted to CAQH. These documents include the Curriculum Vitae, Medical License, DEA certificate, CDC Certificate, IRS Form W-9, Malpractice Insurance face sheet, and more.
The entire application process now takes place online and can be completed in less than two hours. After contracting, Aetna will get the credentialing application from the Council for Affordable Quality Healthcare (CAQH) ProView to begin the credentialing process. When the applicant completes credentialing, their contract will be finalized, and they will receive welcome materials.
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Aetna's insurance coverage
Aetna is recognised as one of the leading providers of health insurance in the United States. It offers a wide range of insurance plans to meet the needs of individuals, families, employers, healthcare providers, and insurance agents/brokers. These include health insurance, dental insurance, and vision insurance.
Aetna's health insurance plans provide access to a network of doctors, specialists, and hospitals. Some plans offer $0 PCP visits, $0 preventive care, and $0 MinuteClinic visits. Additionally, certain plans include a $3 copay for over 200 generic drugs and a $25 allowance every three months for CVS Health brand wellness products.
Aetna also provides Medicaid health plans, including programs such as the Children's Health Insurance Program (CHIP), care for the aged, blind, and disabled, as well as long-term services and supports.
Aetna's network of healthcare providers is extensive, and the company has specific criteria for evaluating and including medical practitioners in its network. Healthcare providers must obtain an NPI (National Provider Identifier) and complete the CAQH registration process before applying to join the Aetna network. The entire process of joining the Aetna network can be lengthy and complicated, typically taking at least 90-120 days for approval.
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Aetna's subsidiary companies
Aetna is a subsidiary of CVS Health, which acquired the company in 2018. CVS Health is a family of companies that includes Aetna, CVS Pharmacy, and MinuteClinic, LLC. CVS Health offers ACA individual and family plans, with access to the Aetna network of doctors, specialists, and hospitals.
Aetna Inc. is the parent company of several subsidiary companies, including Aetna Life Insurance Company and its affiliates. In 1996, Aetna sold its property and casualty subsidiary to The Travelers Companies. That same year, it acquired U.S. Healthcare, and the company's name changed to Aetna Inc. In 1998, Aetna continued its expansion by purchasing NYLCare Health Plans from the New York Life Insurance Company, adding 2.2 million members. The following year, it acquired Prudential HealthCare, making it the largest provider of health benefits in the U.S. with over 21 million members.
Aetna Life Insurance Company, a subsidiary of Aetna Inc., was incorporated in 1853 when the Annuity department separated from Aetna Insurance. Aetna Life Insurance Company offers health insurance plans and is part of the CVS Health family of companies.
First Health, another subsidiary of Aetna, provides direct access to national and regional PPO networks, helping clients manage costs for employee benefit plans. Meritain Health, also part of the Aetna group of companies, offers affordable and accessible employee benefits plans with a focus on promoting healthier living.
Aetna Inc. and its subsidiary companies are not responsible for the content, accuracy, or practices of linked non-Aetna sites, and they are not liable for any products or services described on these sites.
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Aetna's CVS Health plans
Aetna CVS Health offers a range of health insurance plans to support the health needs of individuals and families. These include medical, dental, vision, Medicare, and Medicaid plans.
Aetna CVS Health plans provide access to a network of doctors, specialists, and hospitals, as well as over 1,000 MinuteClinic locations and 24/7 virtual care. Members can benefit from $0 PCP visits, $0 preventive care, $0 MinuteClinic visits, and a $3 copay for over 200 generic drugs. In addition, members receive a $25 allowance every 3 months to purchase CVS Health brand wellness products.
Aetna CVS Health also offers Affordable Care Act (ACA) plans, which are federally and state-funded. These plans are available for individuals and families, with options for those who are low-income, including eligible children, adults, seniors, pregnant people, and people with disabilities.
To learn more about specific Aetna CVS Health plans and their availability in your state, you can visit the Aetna website or download the Aetna Health app. You can also consult with licensed agents to help you choose the right plan for your needs.
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Aetna's health insurance plans
Aetna is recognised as one of the leading providers of health insurance in the United States. The company offers a range of health insurance plans, including ACA individual and family plans, Medicare plans, and Medicaid plans.
ACA individual and family plans are available through the Health Insurance Marketplace, Nevada Health Link, Covered California, and Get Covered New Jersey. These plans offer coverage for a range of services, including doctor's visits, preventive care, MinuteClinic visits, prescription drugs, and adult dental and vision care. Some plans also include a quarterly allowance for CVS Health brand wellness products.
Medicare plans offered by Aetna include Aetna Choice POS, Aetna Choice POS II, Aetna Medicare Plan (HMO), and Aetna Open Access Elect Choice. These plans may have different tiers of coverage, and members can use the Aetna Health app to check whether a particular drug is covered by their plan.
Aetna Better Health provides Medicaid plans in many states across the country. These plans include programs such as the Children's Health Insurance Program (CHIP), care for the aged, blind, and disabled, as well as long-term services and support.
In addition to these standard plans, Aetna also offers health insurance plans through its subsidiary companies, such as Aetna Health of California Inc., Aetna Health Inc. in various states, and Aetna Life Insurance Company.
For healthcare providers who wish to join the Aetna network, there is a credentialing process that typically takes 90-120 days to complete. This process involves submitting various supporting documents, such as a Curriculum Vitae, Medical License, and DEA certificate. Healthcare providers must also obtain an NPI, or National Provider Identifier, before applying to join the Aetna network.
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Frequently asked questions
Aetna is a leading provider of health insurance in the United States. It provides coverage for medical, dental, pharmaceutical, and behavioral health services, as well as long-term care and disability plans.
To join Aetna as a healthcare provider, you must first submit a request for participation and then fill out an application. Aetna will then assess your request and determine if there is a need for your services in your area. If your request is approved, you will receive a provider agreement to sign.
You can enroll in an Aetna health insurance plan through your employer or through Medicare. You can also shop for individual and family plans on the Health Insurance Marketplace or state-specific marketplaces, such as Covered California or Nevada Health Link.
Aetna offers a range of plans with different tiers of coverage. Some plans include $0 PCP visits, $0 preventive care, $0 MinuteClinic visits, and low copays for generic drugs. Aetna also offers dental and vision coverage with select plans.
Yes, members have the right to appeal coverage decisions made by Aetna. Members may also request an independent external review of coverage denials based on medical necessity or experimental status if the member is financially responsible for the service or supply in question.
