Get Aetna Provider Nomination Form 2018-2025

Filling out the Aetna Provider Nomination Form is an essential step for physicians who wish to join the Aetna network. This guide will walk you through each section of the form, ensuring you complete it accurately and efficiently.

Follow the steps to fill out the Aetna Provider Nomination Form accurately.

1. Click the ‘Get Form’ button to access the Aetna Provider Nomination Form online and open it for editing.
2. Begin by filling out the referring member's name at the top of the form. This identifies the person who is recommending the provider.
3. In the provider information section, enter the last name and first name of the physician you want to nominate.
4. Fill in the Tax ID number and the specialty of the provider. Ensure that these fields are accurate to prevent any processing delays.
5. Provide the provider's degree and practice name. This helps Aetna understand the qualifications of the nominee.
6. Indicate the years the provider has been in practice. This information adds context to their experience.
7. Complete the address section, including the street, city, state, and zip code. This ensures proper correspondence.
8. Include the provider's phone number and the name of the office manager for any necessary follow-up.
9. List any hospital affiliations the provider has. Provide the names of each facility to give Aetna further context about the provider's connections.
10. After completing all the required fields, review the form for accuracy. Once verified, you can save your changes, download, print, or share the form as needed.

Complete the Aetna Provider Nomination Form online today and take the first step toward getting your provider nominated.