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Join our network form

Thank you for your interest in becoming a Medicare-Medicaid (Aetna Better Health® Premier Plan) provider. To get started, you can complete our provider intake form. This will help us better understand what services you provide and your location. It will also help us gather any other information needed for the contracting process. 

Tell us more about you

You’ll need to fill all fields with an asterisk (*).

 

Choose contract type
 

If you’re adding a new practitioner to an existing group, you can email us.

Include the official company name and, if you use one, the "doing business as" (DBA) name.
*Are you a part of a medical group?
Be sure to follow this format: XX-XXXXXXX.
This is your National Provider Identifier (NPI) number
Put “N/A” if you don’t have a Medicaid number.
Example: 12345

 

Primary contact person 

Would you like to receive emails from Aetna Better Health Premier Plan?
 

Questions?

 

Just call us at 1-855-676-5772 (TTY: 711).

 

*This is a required field.  

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