Core Requirements for Joining the Aetna Network in Texas:

• CAQH ProView: Aetna mandates the use of the Council for Affordable Quality Healthcare (CAQH) ProView database for healthcare credentialing and recredentialing of healthcare professionals. You must complete your online profile and authorize Aetna to access this information. Ensure your CAQH profile is accurate and up-to-date.  
• Texas License: A current, valid, and unrestricted license to practice in the state of Texas is required. The license must be in good standing with the relevant Texas licensing board.
• Professional Liability Insurance: You need to have current professional liability coverage that meets Aetna’s specific requirements for your specialty and the state of Texas. You will need to provide proof of this coverage.  
• Education and Training: Verification of your completed medical education, residency, fellowships, and any other relevant training is necessary.  
• Board Certification: Information about your board certifications, if applicable to your specialty, will be required and verified with the primary source.
• Work History: You will likely need to provide a detailed work history for the past five years, explaining any gaps longer than six months.  
• Hospital Privileges (for applicable providers): Information regarding your current hospital privileges or admitting arrangements at participating hospitals may be required.
• DEA and Texas CDS Certificates (if applicable): If you prescribe controlled substances, you must provide your current Drug Enforcement Administration (DEA) certificate and Texas Controlled Dangerous Substances (CDS) certificate.
• National Provider Identifier (NPI): A valid NPI is mandatory for participation.
• Tax Identification Number (TIN) and W-9: You will need to provide your TIN for contracting and payment purposes and submit a completed W-9 form.  
• Practice Information: Details about your practice locations, including addresses, phone numbers, and contact information, are required.
• Attestation: You will need to attest to the accuracy of the information you provide during the credentialing process.
• Background Checks: Aetna typically conducts background checks as part of the credentialing process.  

Steps to Credential with Aetna in Texas:

1. Request Participation: Initiate the process by completing the online Request for Participation form on the Aetna website for your specific provider type. Use the same form for Medical and Behavioral Health. https://extaz-oci.aetna.com/pocui/join-the-aetna-network
2. Aetna Review: Aetna will evaluate the need for providers in your service area. If there is a need and they intend to proceed with a contract, you will be notified within approximately 45 days.  
3. CAQH Registration and Authorization: Aetna uses CAQH as their primary source for credentialing data. If you are not already registered with CAQH ProView, you will need to do so. Once registered, ensure your profile is complete and authorize Aetna to access your information by specifically adding Aetna as an authorized plan in your CAQH profile.  https://proview.caqh.org/Login/Index?ReturnUrl=%2f
4. Credentialing Process: Aetna will obtain your information from CAQH and begin the credentialing process, which involves verifying your qualifications with primary sources.
5. Contracting: Once the credentialing process is complete and approved, your contract will be finalized, and you will receive welcome materials.  

Key Considerations:

• CAQH is Central: Ensure your CAQH profile is thorough, accurate, and you have granted Aetna access.
• Separate Contracting and Credentialing: Keep in mind that credentialing and contracting are separate processes, and both must be completed before you are considered in-network.  
• Timeliness: Respond promptly to any requests for information from Aetna or CAQH to avoid delays.  
• Accuracy: Ensure all information provided is accurate and verified. You have the right to correct any information obtained during the credentialing process by working directly with the reporting entities.  
• Recredentialing: Aetna requires recredentialing every three years in most states, requiring the same level of scrutiny as the initial process.  
• Provider Manuals: Refer to the Aetna Provider Manuals for detailed policies and procedures.  
• Contact Aetna: For specific questions about your application status or requirements, contact Aetna’s Credentialing Customer Service at 1-800-353-1232 (for medical and behavioral health) or 1-800-451-7715 (for dental).  

Summary Table: Aetna Credentialing Steps in Texas