Wiki Credentialing Question

[sumathip78@yahoo.com]

Our providers are credentialed with Medicare and Aetna. Do they need to get credentialed
with "Aetna Medicare" the Medicare Advantage Plan insurance?

 

[thomas7331]

The provider’s Aetna contract should state whether or not the Aetna Medicare plan is included in the current contract. If it’s not, it’s probably easy to have it added to the contract without going through the credentialing process since they likely already have all of the information that’s needed.

If they’re not contracted with the Aetna Medicare plan, they can still see those patients, but just may get paid at out of network benefit levels.

 

[sumathip78@yahoo.com]

I really appreciate it. Thanks for your reply.