January 2021 Aetna News: Tips on Credentialing and Contracting your Clients with Aetna
We work closely with members of the Commercial Payer Relations Committee on issues important to HBMA members. Members of the committee have told us we can do a better job with credentialing and contracting your clients. We agree.
We’re working hard to improve our credentialing and contracting process. We’re even rolling out a new tool to help providers, or their designees, to get more information on the status of a request for participation. More on that in a future article.
We’ve asked committee members to compile a list of their pain points. Here are our suggestions to make things go as smoothly as possible for everyone.
Using CAQH ProView®
We get applicant’s information from CAQH ProView®.
There are two state exceptions:
- In Washington, we use ProviderSource™ from Medversant
- In Arkansas, we use the Arkansas State Medical Board’s Centralized Credentials Verification Service (CCVS)
When you’re submitting your client’s information through ProView, make sure:
- Their application is complete and current before submitting their request to participate with us
- You grant us authorization to access their completed application
Common reasons for delays
Here are the most common items that delay processing ProView applications.
- Incomplete or missing demographic or personal information (service locations, state license(s), board certification(s), education/training, hospital privileges, responses to confidential information questions (including explanation to “yes” answers))
- New service location for a provider who has recently relocated
- Missing service location in the state the provider is applying to participate in
- The provider is an outpatient provider (we don’t process applications for inpatient only, hospitalists or hospital-based providers)
Watch for typos
A completed request for participation is important. But so is accuracy.
Watch out for these common mistakes:
- Extra or unwanted characters, like blank spaces or punctuation
- Invalid ZIP code, taxpayer ID number (TIN), date of birth or address
- Missing or invalid fax number, email address or license number
Speaking of TINs
If the applicant is asking to join an existing contracted group, make sure they include that TIN on their request form. If we can’t find the provided TIN in our system, this may delay the request while we verify the correct information.
We’re working hard to improve our credentialing and contracting process. So your feedback is valuable to us. If you need help with an existing request for participation call us at 1-800-353-1232 (TTY: 711). Select option 3 to talk to a representative.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
©2020 Aetna Inc.