AETNA BETTER HEALTH®
AETNA BETTER HEALTH® KIDS Practitioner information change
Make sure your contact information is current with us. If you want to make changes to your information, all you have to
do is fill out the form on page 2. It’s easy!
Make a change request today You can fill out one form per provider in your practice. You can make changes to your:
Physical and mailing addresses
Service Location Additions
Practitioner Resignation/Retirement (Term Date)
You’ll also want to attach important information with your change request, like a W-9 or your licensure.
Remember to complete the whole form.If you have more than ten providers that require changes, use our provider roster update spreadsheet instead.
Send the updated spreadsheet to ABHProviderRelationsMailbox@AETNA.com.
Your information is important
Your information helps us:
Send payment to you without delay or error
Make updates in a timely manner
Send important information about new products and initiatives
Meet state and NCQA requirements
We’ll take care of the rest Once we receive your change request, we’ll process and complete it within 30 business days. [SP1]
Remember, we can only process requests for in-network providers with a signed, executed agreement on file. So, if you’re an out-of-network provider
and want to join our network, fill out our Out of Network Request to Join Form . For more questions about enrollment,
contact Provider Relations at 1-866-638-1232.