Aetna Behavioral Health: Credentialing and Billing for Therapists and Psychiatric Providers

To bill Aetna in-network for mental health services, you credential with Aetna’s behavioral health network, not just Aetna in general. Keep a complete, attested CAQH ProView profile shared with Aetna, request to join through Aetna’s provider site, sign the contract, and wait for an effective date. Aetna Medicare Advantage and Aetna Better Health (Medicaid) plans can need separate participation, so check which Aetna products your contract covers.

Aetna is one of the largest commercial insurers in the US, and part of CVS Health. For most Aetna commercial plans, behavioral health is managed within Aetna, but the network, rules and contacts for mental health are distinct from Aetna’s medical side.

Aetna products are not one network

Product	What it is	Credentialing
Aetna commercial (employer and individual plans)	Most Aetna members	Aetna behavioral health network participation
Aetna Medicare Advantage	Medicare plans run by Aetna	Check whether your contract includes Medicare products; you also need your own Medicare enrollment
Aetna Better Health	Medicaid managed care plans in certain states	Separate credentialing and contract under the state program
Employer plans administered by Aetna	Self-funded employers using Aetna’s network	Usually covered by your Aetna network contract; benefits vary by employer
EAP programs	Short-term counseling through an employee assistance program	Separate EAP network and rules

Knowing which product a patient has matters before the first visit: being in-network for Aetna commercial does not automatically mean you are in-network for that patient’s Aetna Medicaid or Medicare plan.

Credentialing with Aetna

1. Get your basics in order: state license, individual NPI with the correct taxonomy, malpractice coverage, and a group NPI if you bill as a group.
2. Complete and attest CAQH ProView, and give Aetna access to your profile. Aetna, like most commercial payers, pulls credentialing data from CAQH.
3. Request to join the network through Aetna’s provider website. If Aetna says the network is closed in your area, ask about exceptions for a language, specialty or underserved population.
4. Complete the application and sign the contract. Check which products and locations it covers.
5. Get your effective date in writing, then set up electronic claims, remittance (ERA) and payments (EFT).

Plan on 60 to 120 days in most markets. See how to get paneled with insurance for the general process.

Billing notes for Aetna

• Verify behavioral health benefits for each patient, including copay or coinsurance, deductible, and whether authorization is needed for the service.
• Telehealth: use the place of service and modifier Aetna’s current policy requires (see our telehealth billing guide).
• Psychotherapy time: document start and stop times, especially for 90837 (see 90837 vs 90834).
• Higher levels of care such as IOP, psychological testing or TMS usually need prior authorization.
• Claims and remittance are handled through Aetna’s provider portal and your clearinghouse. Enroll in ERA and EFT early so payments post automatically.

Common Aetna denials in mental health

Denial	Usual cause	Fix
Out of network	Credentialed for one Aetna product but the patient has another	Check the patient’s product; credential with that plan if needed
Provider not eligible	Clinician not yet effective, or not linked to the group	Confirm effective date and group linkage
Authorization required	Service needed pre-approval under the patient’s plan	Request authorization; appeal with records if appropriate
Missing or invalid information	Subscriber details, taxonomy or NPI mismatch	Correct and resubmit

Our guide to denial codes explains the codes on Aetna remittances.

Recredentialing

Like most payers, Aetna recredentials providers periodically, commonly about every three years. Keep CAQH current and re-attest every 120 days so recredentialing does not interrupt payment.

We are an independent billing and credentialing company, not affiliated with Aetna. Payer rules change, so confirm current requirements on Aetna’s provider site. Our mental health credentialing team handles Aetna applications and follow-up, with weekly status updates.

Frequently asked questions