What PAs Need to Know About Aetna’s 2025 Credentialing Policy

05/05/2025

Aetna’s New Credentialing Rules for Physician Assistants: What PAs Need to Know 

Starting Mar. 1, 2025, Aetna introduced a new credentialing requirement for physician assistants (PAs), aligning with evolving industry standards. This policy, affecting new and existing PAs in Aetna’s networks (except hospital-based or delegated PAs), mandates the completion of a Council for Affordable Quality Healthcare (CAQH) application for credentialing or recredentialing. Here’s a breakdown of the changes and steps PAs should take to comply and maintain network participation. 

Overview of the Credentialing Requirement 

Aetna’s new policy requires all non-hospital-based, non-delegated PAs to undergo credentialing or recredentialing to participate in its commercial, Medicare, and Student Health networks. The initiative reflects industry-wide efforts to standardize provider qualifications and ensure quality care. 

  • New PAs: Individual PAs joining Aetna’s networks must complete the provider onboarding process and submit a CAQH application for initial credentialing. 
  • Existing PAs: Current individual PAs must complete recredentialing, with Aetna scheduling them into a recredentialing cycle over the coming months. A CAQH application is also required. 

Hospital-based or delegated PAs are exempt from this requirement. 

How to Complete the CAQH ProView™ Application 

To comply with Aetna’s credentialing process, PAs must submit a CAQH ProView™ application. Follow these steps: 

  1. Log In: Access the CAQH provider portal at proView.caqh.org. 
  2. Update Information: Ensure your application reflects your most current professional details, including licensure, certifications, and practice information. 
  3. Verify Status: Confirm your application is in “Reattestation” (for recredentialing) or “Initial Application Complete” (for new PAs) status. 
  4. Authorize Access: Grant Aetna permission to review your application data. 

A completed and authorized CAQH application is mandatory to begin or continue the credentialing process. 

Implications for Physician Assistants 

The new requirement introduces several considerations for PAs: 

  • Administrative Effort: Completing or updating a CAQH application and maintaining accurate records will require time and attention to detail. 
  • Network Participation: Failure to comply could result in exclusion from Aetna’s networks, limiting patient access and revenue potential. 
  • Timely Action: Existing PAs should prepare for their recredentialing cycle, as Aetna will phase this process over several months. 

Steps for PAs to Prepare 

To ensure a smooth credentialing or recredentialing process, PAs should: 

  1. Update CAQH Promptly: Log into the CAQH portal now to verify and update your application, ensuring all information is current and accurate. 
  2. Monitor Communications: Watch for Aetna’s notifications about your recredentialing cycle (for existing PAs) or onboarding steps (for new PAs). 
  3. Seek Support: If unfamiliar with CAQH ProView™, consult practice administrators or credentialing specialists for guidance. 
  4. Maintain Records: Keep copies of your application and related documents to streamline future recredentialing or audits. 

Source: Aetna 

 

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