Adding Aetna’s network of providers can grow your practice, improve patient access, and ensure seamless insurance payments. However, the provider credentialing and enrollment process can be an apparent obstacle if you are unsure where to begin. This guide breaks down the process in simple terms so that you can join the Aetna network comfortably and confidently.
What is Provider Credentialing?
Provider credentialing is the process by which Aetna checks your professional history, licenses, and qualifications. Credentialing makes sure that all network providers satisfy Aetna’s quality standards and healthcare laws. Credentialing is necessary to become an in-network provider and achieve prompt insurance reimbursement.
Credentialing safeguards patients and providers by making sure that all healthcare professionals in the network are properly qualified and licensed.
Collect Required Documents
Prior to moving forward with the enrollment process, gather all required documents. These most typically are:
- Current medical licenses
- DEA certificate (if required)
- Board certifications
- Curriculum vitae (CV)
- Malpractice insurance details
- Hospital affiliations
Organizing your documents in advance facilitates the process and minimizes delays. Various practices also utilize medical billing audit services to review all provider documents and billing files for accuracy prior to submitting them.
Aetna Provider Application
Second, fill out the Aetna provider application. You can either download it from the Aetna provider portal or call provider services. Make sure you fill it out properly with the proper information about your education, licenses, specialties, and practice details.
Mistakes or missing information will delay your application, so check everything twice. Your biller and medical coder can normally complete your application correctly, especially if it is complex billing or more than one practice location.
Submit Your Application
Once done with the application, send it via the portal or by mail as directed. Aetna will now review your documents and check your credentials. This is a crucial step, so make sure everything is accurate and current.
Background Verification
Aetna checks your background carefully to confirm your:
- Medical certifications and licenses
- Work history and hospital affiliations
- Malpractice record
Reply promptly if Aetna requires more information at this stage. Fast turnaround prevents delays and speeds up your approval. Most practices also verify with a professional medical billing at this stage to ensure that all of their billing and claims information they report on their credentialing application is consistent.
Credentialing Committee Review
Once your documents and background check are finalized, your application is submitted to Aetna’s credentialing committee. The committee checks that you meet clinical, professional, and ethical criteria. If your application is approved, you’ll be formally notified of your in-network status.
Signing the Contract
When approved, you’ll receive a provider agreement from Aetna. Carefully review the contract, including:
- Reimbursement amounts
- Billing requirements
- Participation conditions
Sign and return the contract as instructed. The contract will make you an in-network provider and allow you to begin submitting claims.
Access Aetna Systems
Once your contract has been completed, Aetna provides you with access to its computer systems. The systems allow you to:
- Submit claims
- Verify patient eligibility
- Verify payment status
- View provider resources
Getting to know these systems literally saves you from billing errors and brings you closer to reimbursement earlier. Medical billing audit services can be extremely useful at this juncture to audit your billing processes and assist you in ensuring that you’re compliant with Aetna’s requirements.
Maintain Credentialing
Credentialing is not a one-time process. Aetna re-credentials providers every 36 months. Maintain licenses, certifications, and insurance current, and respond promptly to verification requests. Being well-organized will keep your practice in compliance and avoid unnecessary delays in claims processing.
Tips for a Smooth Enrollment Process
- Be Organized: Keep all applications and documents in one place for easy access.
- Respond Promptly: Respond to Aetna’s questions immediately to avoid delays.
- Double-Check Forms: Mistakes will slow up the approval process, so double-check everything.
- Use Expert Help: Not using a medical billing and coding expert or medical billing expert will make things simpler and prevent mistakes.
Benefits of Being an Aetna Network Provider
- Expand patient access to your services
- Receive timely and accurate payments
- Become a trusted provider
Enjoy access to support and resources from Aetna’s network of providers
By attaining credentialing and enrollment, your practice can expand without allowing patients to miss out on in-network benefits.
Conclusion
Aetna provider enrollment and Aetna credentialing may be daunting, but it can be tackled step by step. Begin with getting your documents in order, fill out and submit your application thoroughly, and answer all verification inquiries quickly. Utilizing medical billing audit services and employing a professional medical billing and coding will ensure accuracy and facilitate the process.
Having an organization and current credentials allows you to provide patient care as you are also reaping the benefits of being an Aetna network provider. Enrollment and credentialing may be a breeze, be successful, and be smooth if you have the correct strategy.
