Credentialing by payer
How to get credentialed with Aetna
Aetna is a national commercial payer, and joining its network follows the same three-part pattern as every commercial plan: a participation request, credentialing against your CAQH profile, then a contract with an effective date. Applications go through Availity. Provider Enrollment Credentialing Services handles Aetna applications for physicians, nurse practitioners, physician assistants, therapists and groups in every state, at $200 per application per provider, followed up regularly until approval.
How Aetna takes applications
Aetna takes new-provider requests through its online Request Participation form; once accepted it pulls credentials from CAQH ProView and issues a contract for signature. Aetna also runs Medicare Advantage and, through Aetna Better Health, Medicaid plans in several states, each with its own application.
Aetna commonly asks for a current CAQH attestation and a malpractice certificate before it will open a file, and it closes out requests where the service area is already at capacity for the specialty.
What to have ready before you apply
- A CAQH ProView profile that is complete, attested within 120 days, and set to allow Aetna to view it.
- Your NPI, the group Tax ID and Type 2 NPI if you bill through a group, and a W-9 whose legal name matches your Tax ID letter exactly.
- State license, DEA and state controlled-substance registration where you prescribe, board certification, and a current malpractice certificate of insurance.
- A five-year work history with month and year for every position and an explanation for any gap over three months.
- Medicare enrollment (PECOS) if you want the plan's Medicare Advantage line as well as its commercial line.
What happens after you submit
The plan checks network need for your specialty and county, then verifies each credential with the issuing source, then routes the file to a credentialing committee that meets on a schedule, usually monthly. Approval produces a contract for signature, and the effective date is set when the plan countersigns. The two places applications stall are the network-need step, where a closed panel needs an appeal or a later retry, and the verification step, where any mismatch between your CAQH profile, your license record and your application sends the file back. We reconcile all three before submitting and follow up with Aetna on a regular schedule so a stalled file is caught in the same month.
Pricing
Aetna application $200 per provider; if you also need the CAQH profile built, $500; Medicare enrollment $500; ongoing maintenance, which keeps the Aetna contract and every other one current with re-attestations and recredentialing, $100 per provider per quarter. Every service and price, or start the intake.
Questions about Aetna
How long does Aetna credentialing take?
Plan on 90 to 120 days from a complete application. The clock starts when the plan opens a file, not when you submit, so a missing CAQH attestation or malpractice certificate can add weeks before day one. The effective date is set when the contract is countersigned; claims before that date are out of network.
Does Aetna use CAQH?
Yes. Like nearly every commercial payer, Aetna verifies credentials against your CAQH ProView profile, so the profile has to be complete, attested within the last 120 days, and authorized for the plan to view before the application will move.
What if Aetna says the panel is closed?
A closed-panel response is about network need in your county and specialty, not about you. It can be appealed with a letter that shows patient demand or a gap in access, and it is worth re-requesting after a quarter. We track closed-panel dates and re-request automatically for maintenance clients.
What does PECS charge for a Aetna application?
$200 per application per provider, billed half at engagement and half at approval. That covers the request, the CAQH readiness check, document submission, regular follow-up, and recording the effective date and contract terms when the plan approves.
Want Aetna handled? Start the intake and pick the plans you want in section 5.
Answers cover PECS services, prices and process. For legal, tax or clinical questions please consult a professional.
Plan procedures change; this page reflects Aetna's process as of September 2026.