Get Aetna - Coventry Facility Credentialing Questionnaire

Completing the Aetna - Coventry Facility Credentialing Questionnaire is essential for healthcare facilities seeking to participate in Aetna's network. This guide provides clear, step-by-step instructions to help users navigate the form efficiently and accurately.

Follow the steps to successfully complete the questionnaire online.

1. Click ‘Get Form’ button to obtain the questionnaire and access it in your chosen format.
2. Fill in your name, title, and the date at the top of the form. Ensure that your details are accurate and complete.
3. Provide the addressee’s information, including their title and the company name. This information is important for proper communication.
4. Enter the facility’s street address, city, state, and zip code. Double-check for any typos to avoid processing delays.
5. Fill in the phone and fax numbers where Aetna can reach you. This ensures that they can contact you for any questions or follow-ups.
6. Input the organizational provider’s 14-digit PIN. This will help in identifying your facility in Aetna’s system.
7. Respond to the action requested for completing the facility credentialing questionnaire by reading and understanding the information required.
8. Provide the signed and dated attestation at the bottom of the form confirming the accuracy of your information.
9. Include a copy of the facility's current W-9 and the tax identification number, as this documentation is critical for credentialing.
10. Supply the Medicare certification number, and indicate which Medicare part applies (A, B, or C) based on the services your facility offers.
11. Attach copies of any relevant licenses, registrations, accreditations, and survey reports required by Aetna.
12. Indicate whether you have professional liability insurance coverage and provide the necessary details if applicable.
13. Specify whether your facility maintains an Advance Directive policy and submit the required documentation if not.
14. Check the applicable box for your facility type and circle any relevant accreditation or certification.
15. Sign and date the attestation section, ensuring all information submitted is true and complete.
16. After completing the form, save your changes. You may choose to download, print, or share the form as needed.

Complete your Aetna - Coventry Facility Credentialing Questionnaire online today!