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Aetna credentialing
Can anyone give me any insight into Aetna credentialing as of 2024. Prior to 1/1/24 Aetna used Pref One for their network credentialing. As of 1/1/24, Pref One is under United Healthcare. Because of this all of our providers are now considered out of network according to Aetna and we need to get credentialed directly with Aetna. In the mean time we have several members with denied claims or claims getting processed as of out of network. Can anyone confirm this information or give me any insight into what they have done for credentialing with Aetna starting 1/1/24?
Thank you.
Служба підтримки клієнтів працює на UserEcho
I don't have any insights. We are going through the same thing here. I was wondering as well if other facilities had the same Aetna events happening.
Yes, Aetna was dropped from Preferred One 12/31/23. Depending on what State you are in, depends on who you need to contact for credentialing/contracting. Since we have locations in both ND & MN, our contracting/credentialing has been a little messy because both of those States are handled differently for Aetna.
ND/SD/NE - we go directly through Aetna - Michael Rickenback (Senior Network Manager) Mike.Rickenback@aetna.com
MN/KT/MI/WI - we go through First Health for Aetna because we already had a contract with First Health prior to this. But here are some of the contacts for both Aetna & First Health we dealt with for our MN contract - Johanna Nelson, Senior Manager for MN Market nelsonj2@aetna.com & Karyl Jacobson (Mgr, Contract Negotiation) kajacobson@firsthealth.com
But you will have to do up a new contract and do new credentialing in order for you to be able to see Aetna clients in 2024.
Thank you. We will follow up with Aetna. Best of luck to you.
Debbie
We did our credentialing in 2023 but we followed the same process as noted above - First Health and Aetna - as we are only doing business in MN. I would suggest following up weekly as the process was not smooth for us. We had to submit some items more than once. Best of luck! I hope it is a smoother process for you!
We are not part of First Health so this might be a longer process because of that. Thank you for all the feed back. I will be reaching out to Johanna Nelson to see if she can guide me.