Join our network form

Thank you for your interest in becoming an Aetna Better Health® of Michigan 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.

New contract

Amendment

CHOOSE PROVIDER

*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 Be sure to follow this format: XX-XXXXXXX.

*NPI number This is your National Provider Identifier (NPI) number.

*Medicaid number Put “N/A” if you don’t have a Medicaid number.

*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 Michigan?

Yes

Questions?

Just call us at 1-866-316-3784 (TTY: 711).

Working with us

Programs and services

Resources

Our network

Join our network form

Tell us more about you

Choose contract type

Primary contact person

Questions?