Our goal is to create a collaborative relationship with you and all of our participating providers. We are committed to assisting you in understanding the policies and procedures to follow in providing high-quality services to our Aetna Resources For Living members. The Aetna Resources For Living staff is available to assist you with authorization procedures, claims payment and other important processes, as outlined in the provider agreement/contract. From time to time, we may amend these policies or implement new policies and procedures. In such instances, we will give you a minimum of 30 days’ notice regarding any new requirements.
Provider credentialing and recredentialing
Our Aetna Resources For Living provider network is made up of licensed professionals in the fields of psychology, psychiatric nursing, clinical social work, marriage and family counseling, and chemical dependency. These licensed clinicians may also be certified through the Employee Assistance Professionals Association or the Substance Abuse Program Administrators Association, as well as other behavioral health certifications. We encourage our Aetna Resources For Living providers to seek CEAP credentialing whenever possible. Credentialing providers with a wide array of specialties ensures we are able to meet the diverse needs of the members and companies we serve.
Once a provider joins the Aetna Resources For Living provider network, he or she is required to be recredentialed every three years, except where state law or regulations mandate recredentialing more frequently. Credentialing information must be current and not older than 180 days at the time of the credentialing/peer review decision.
The required file documentation includes:
•Application, including information on licensure and certification
•Attestation
•Committee decision regarding results of file review
•Committee decision date
•Primary verification evidence (in the United States only)
•Malpractice history
•Information regarding loss, sanction, limitation of licensure, Drug Enforcement Administration certification, participation in a Medicare or Medicaid provider network or U.S. Office of Personnel Management programs
•History of medical conditions or substance abuse
•Results of office assessments and any re-reviews (where applicable)
•Results of quality improvement activities (as applicable) or other performance monitoring
•Member complaints
Nondiscrimination
In no instance would Aetna limit or deny participation to any provider due to reasons of age, race, gender, color, religion, national origin, ancestry, disability, marital status, sexual orientation or any characteristic protected under state, federal or local law. In addition, no provider would be terminated due to advocating on the member’s behalf.
Notice of status changes
You are required to notify Aetna Resources For Living within 14 days, either by telephone or in writing, of any changes related to the following:
•Change in professional liability insurance
•Change of practice location, billing location, telephone number or fax
•Status change of professional licensure, such as suspension, restriction, revocation, probation, termination, reprimand, inactive status or any other adverse situation
•Change in tax identification number used for claims filing
•Malpractice event
•Change in availability of office hours or after-hours coverage or an extended vacation
Mail correspondence regarding changes to:
Aetna Behavioral Health
1425 Union Meeting Road
PO Box 5
Blue Bell, PA 19422
Or fax to:
Attn: Aetna EAP Provider Relations at 860-907-4337
Direct your questions to:
Aetna EAP Provider Relations telephone line at 1-888-632-3862 (between 8 a.m. and 5 p.m. ET)