Who they are
Plan types on the card
Aetna Choice POS II, Managed Choice, Open Access plans, HMO products, Medicare Advantage, and Aetna Better Health Medicaid plans. A substantial share is self-funded ASO.Enrollment and credentialing
Start at aetna.com/health-care-professionals. Many provider transactions run through Availity. Credentialing generally pulls from CAQH.EDI, ERA, and EFT
Standard three-part enrollment. Confirm ERA routing to your current clearinghouse and EFT to the PC’s operating account.Appeals
Reconsideration then formal appeal, with the track depending on plan type and line of business.Quirks worth knowing
- Aetna Dental is a separate network with separate credentialing. Medical participation does not include dental.
- Behavioral health may be carved out depending on the plan — confirm per contract.
- Self-funded volume is substantial, so ERISA analysis applies to a large share of appeals.