Credentialing criteria

Aetna Better Health of West Virginia’s network includes many hospitals, physicians, surgery centers, ancillary providers, and centers of excellence throughout the United States.

Aetna Better Health of West Virginia physicians have qualifications that must be met for participation such as:

  • 24 hour/day, 7 day-a-week coverage
  • A current, valid state license to practice medicine
  • Staff privileges at a participating hospital
  • An active DEA certificate (if applicable)
  • Verification of medical school completion, residency training and fellowship
  • Verification of board certification (in specialty being practiced)
  • Current professional liability insurance that meets state minimum requirements
  • Acceptable professional claims liability history, including the National Practitioners Data Bank (NPDB)

The Health Care Credentials and Data Collection Act requires uniform forms to be utilized in order to collect the credentials data commonly requested by health care entities and health care plans for purposes of credentialing and re-credentialing.

We are now accepting provider credentialing applications through CAQH Universal Provider Datasource. This system is a national provider credentialing application initiative from the Council for Affordable Quality Healthcare. The easy-to-use, streamlined database is the single repository of participating health plans for healthcare provider information, alleviating the need for physicians and other healthcare providers to complete and submit many different credentialing forms for multiple health plans, hospitals and other healthcare organizations. More than 300,000 providers are now reducing paperwork and administrative costs through the UPD.