Join our network form

Thank you for your interest in participating as an Aetna Better Health^® of Illinois provider.

Provider intake questions

Please answer these questions in order for us to have a better understanding of what services you provide and your location, as well as other pertinent information that’s needed for the contracting process.

*Select contract type

If you are adding a new practitioner to an existing group, please email the Provider Relations team.

New contract

Amendment

Select provider

Provider information

*Provider’s name Include the official company name and, if you use one, the "doing business as" (DBA) name.

*Are you a part of a medical group?

Yes

*Tax ID number Please follow this format: XX-XXXXXXX

*NPI number Your National Provider Identifier number

*Medicaid number If you do not have a Medicaid number, put NA.

*City

*State

*Zip Code Example: 12345

*Primary Service County

*Medicaid Region

Primary contact person

*PREFIX

First name

Last name

Title

*Phone

*Email

Would you like to receive emails from Aetna Better Health of Illinois?

Yes

Have any questions?

If you’re in need of additional information, please contact Aetna Better Health of Illinois at 1-866-329-4701 (TTY: 711).

*This is a required field.

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