Aetna billing and credentialing
Billing and credentialing for Aetna commercial, Medicare Advantage and Aetna Better Health (Medicaid) members.
Working with Aetna
Aetna is part of CVS Health. It offers commercial plans, Medicare Advantage plans and Medicaid plans under the Aetna Better Health name in several states.
Plan types we bill:
- Commercial plans
- Medicare Advantage
- Aetna Better Health (Medicaid)
Credentialing and enrollment
Credentialing uses your CAQH ProView profile, so it must be complete, attested within the last 120 days and authorized for the payer before the application is reviewed.
Prepare
Licenses, NPI, CAQH and group details checked and updated.
Apply
Application submitted for each provider and location.
Follow up
Status checked every 1 to 2 weeks until approval.
Confirm
Effective date and participation confirmed before billing.
Claims, eligibility and portals
Aetna uses Availity for eligibility, claim status, authorizations and claim submissions. Filing limits depend on your contract and plan.
Denials we prevent with Aetna
- Provider not credentialed or not linked to the group TIN
- Missing prior authorization for services on the payer’s list
- Eligibility or coordination of benefits issues
- Coding edits and bundling under payer policy
- Claims filed after the contract’s filing limit
Questions about Aetna
How long does Aetna credentialing take?
Commercial credentialing commonly takes about 60 to 120 days, depending on the market and how complete the application is.
Trademarks belong to their owners. MedAi Billing Solutions is an independent billing company, not affiliated with any payer or government agency.
Get help with Aetna claims
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.