Behavioral Healthcare Technology
DENmaar Guardian EHR/RCM Revolution

Aetna Insurance Provider Credentialing is recognized as one of the leading providers of health insurance in the United States. Aetna continues to grow stronger, with millions of users enjoying its medical plan. Hence many physicians and medical practitioners want to become participants in the Aetna healthcare network. To become a participant, however, healthcare services need to apply for Aetna Insurance Provider Credentialing.

Like we mentioned, Aetna behavioral health provider credentialing has an extensive network of people who subscribe to their health insurance. If accepted as part of the network, a medical service provider naturally becomes an in-network provider and people with Aetna plan will be more inclined to use their particular medical service.

The Process to Apply For Aetna Insurance Provider Credentialing

The entire process of applying to get into any insurance providers network can be long and complicated. However, it is necessary to tap into those clients who have insurance, thus making the process mandatory to run a successful medical practice.

1. Obtain a National Provider Identifier

The NPI, also known as National Provider Identifier, is a ten-digit unique identification number used to replace provider identifiers such as the unique provider identification number in HIPAA standard transactions.
Healthcare providers must obtain an NPI in accordance with HIPAA regulations. AN NPI should be obtained before applying to get into the Aetna network.

2. Request for Participation

Aetna requires any medical provider with interest in participating in their network to first submit a request for participation before filling up the application. This request is then later 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 Aetna provider service center directly. It is crucial to have your medical office’s tax I.D and medical license number in hand during the process. After review, Aetna will send your provider agreement via e-mail for signature.

3. Join CAQH UPD

The CAQH Unique provider data source is an online tool that conveniently gathers information required by health plans to obtain provider credentialing. The CAQH registration process prevents providers from submitting the same information to multiple health insurance plans. The medical practitioners are required to login to the CAQH page to complete and activate the registration process.

4. Completing the Application

Once you have obtained the NPI, and have completed the registration process with CAQH, the next step is to authorize Aetna to gain access to your enrollment application and other information. The entire application now takes place online and can be completed in less than two hours. The Aetna module is designed to save your application form automatically if multiple sessions are necessary.

5. Documentation

All supporting documents required for assessment should be submitted to CAQH. The documents needed are Curriculum Vitae, Medical License, DEA certificate, CDC Certificate, IRS Form W-9, Malpractice Insurance face sheet, etc. Aetna is very particular about who they include in their in-network. Their CVO uses strict guidelines to evaluate each medical practitioner’s qualifications, reputation, and competence.

  Whom We Help with Aetna Credentialing & Enrollment

• •     Physicians
• •     Physician Assistants
• •     Nurse Practitioners
• •     Urgent Care Facilities
• •     Therapists
• •     Audiologists
• •     Psychologist
• •     Behavioral Health Providers
• •     Physical, Occupational, and Speech Therapists

  Join Aetna as an In-Network Provider with DENmaar

Being an Aetna in-network provider can be a very long and tedious process. The entire process requires at least 90 – 120 days to be completed and approved. There is a lot of paperwork, which makes the whole process quite frustrating for medical practitioners who want to accept clients with medical insurance. Aetna’s network is extensive, and harbors other insurance companies as well. you can get Meritain health insurance credentialing, Coventry insurance credentialing services etc. with the help of Aetna. That is where the professional assistance of DENmaar comes into play. With the help of our credentialing experts, we can walk you through the entire process without and complications and hassle so that you can work on other core areas of your medical practice.

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Denmaar aids in the process of adding therapists to private practice insurance credentials. Navigating the treacherous process of getting on insurance panels can be overwhelmingly complex. The entire therapist credentialing process takes up to 90 -120 days to culminate. Even while the initial application process is done, you still have to be available on call for 45-minute conversations relevant to your credentialing process.

The process of Adding Therapists is lengthy, with lots of paperwork to manage, and steps to follow. This is where Denmaar comes to the rescue of medical practitioners. We understand how important the time of healthcare professional is, and offer robust credentialing services that take care of the complicated process for you.

To make things simpler, here is the step by step process of getting on an insurance panel for Adding Therapists:

1. Getting Your Information in Order

As we mentioned before, Insurance credentialing requires a lot of information and documents from the practitioner.

They are:

•   Licensure Information
•   NPI Number
•   Resume
•   Proof of Malpractice Insurance
•   Taxonomy Code
•   Proof of Liability Insurance from Landlord (Applicable on if you are renting)
•   Credentialing Paperwork

2. Fill Out Your CAQH

You will find many companies who use the Council of Affordable Quality Healthcare for the purpose of credentialing. Before filling out the CAQH form, you are required to hold an authentic resume with no gaps in employment. The application is supposed to be completed online via the CAQH hub. The entire process can be extremely confusing to follow, but we at Denmaar assist you till the end.

 3. Contact provider Relations

Once you have gone through the CAQH process, you are now afforded the liberty of choosing which insurance panel you want to be on. The insurance companies you choose may vary in the department of reimbursement rates, provider friendliness, payment speeds, etc.
Some companies may have their own sets of rules and requirements to apply. Now here you might face an issue of rejection, or not being accepted because the panel is full.

In such cases, you can do the following to build relationships with networks to gain access for future openings:

•  Evening and Weekend Availability
•  Experience with special populations
•  Crisis services
•  Handicap accessible facilities
•  Being located in an underserved area
•  Multilingual fluency
•  Having an in-network referral source.

4.     Submit Application

Once you have taken care of the documentation and decided on which insurance panel to join, it’s time to submit the application and wait. The entire process of getting paneled is relatively swift, culminating within 9-10 hours.
All you have to do now is a follow-up. You have to keep tabs on the status of your application. Chances are it might expire while still in the process if taken too long, and you don’t want to start again. The insurance companies have to be notified every time you submit a document to ensure it has reached them.

5.     Review after Approval

Once you have received approval, it is still not an appropriate time to celebrate. Do the following to be on the safer side.

•  Review your contract carefully before signing
•  Keep a file with the agreement and any addendums ready for future reference.
•  Learn more about the insurance provider’s portal on their official website.
•  Collect a list of phone numbers for the claims department, pre-authorization department, and provider relations.

Once you have taken care of the above bucket list, you are ready to sign. To speed up the process, Denmaar will help you submit your claims electronically. This will help you save time, money, and paper.