Credentialing Corner – May 2025

Aetna’s New Credentialing Rules for Physician Assistants: What PAs Need to Know 

Starting Mar. 1, 2025, Aetna introduced a new credentialing requirement for physician assistants (PAs), aligning with evolving industry standards. This policy, affecting new and existing PAs in Aetna’s networks (except hospital-based or delegated PAs), mandates the completion of a Council for Affordable Quality Healthcare (CAQH) application for credentialing or recredentialing. Here’s a breakdown of the changes and steps PAs should take to comply and maintain network participation. 

Overview of the Credentialing Requirement 

Aetna’s new policy requires all non-hospital-based, non-delegated PAs to undergo credentialing or recredentialing to participate in its commercial, Medicare, and Student Health networks. The initiative reflects industry-wide efforts to standardize provider qualifications and ensure quality care. 

• New PAs: Individual PAs joining Aetna’s networks must complete the provider onboarding process and submit a CAQH application for initial credentialing. 

• Existing PAs: Current individual PAs must complete recredentialing, with Aetna scheduling them into a recredentialing cycle over the coming months. A CAQH application is also required. 

Hospital-based or delegated PAs are exempt from this requirement. 

How to Complete the CAQH ProView™ Application 

To comply with Aetna’s credentialing process, PAs must submit a CAQH ProView™ application. Follow these steps: 

1. Log In: Access the CAQH provider portal at proView.caqh.org. 

2. Update Information: Ensure your application reflects your most current professional details, including licensure, certifications, and practice information. 

3. Verify Status: Confirm your application is in “Reattestation” (for recredentialing) or “Initial Application Complete” (for new PAs) status. 

4. Authorize Access: Grant Aetna permission to review your application data. 

A completed and authorized CAQH application is mandatory to begin or continue the credentialing process. 

Implications for Physician Assistants 

The new requirement introduces several considerations for PAs: 

• Administrative Effort: Completing or updating a CAQH application and maintaining accurate records will require time and attention to detail. 

• Network Participation: Failure to comply could result in exclusion from Aetna’s networks, limiting patient access and revenue potential. 

• Timely Action: Existing PAs should prepare for their recredentialing cycle, as Aetna will phase this process over several months.