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:
- Log In: Access the CAQH provider portal at proView.caqh.org.
- Update Information: Ensure your application reflects your most current professional details, including licensure, certifications, and practice information.
- Verify Status: Confirm your application is in “Reattestation” (for recredentialing) or “Initial Application Complete” (for new PAs) status.
- 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:
- Update CAQH Promptly: Log into the CAQH portal now to verify and update your application, ensuring all information is current and accurate.
- Monitor Communications: Watch for Aetna’s notifications about your recredentialing cycle (for existing PAs) or onboarding steps (for new PAs).
- Seek Support: If unfamiliar with CAQH ProView™, consult practice administrators or credentialing specialists for guidance.
- Maintain Records: Keep copies of your application and related documents to streamline future recredentialing or audits.
Source: Aetna