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Why keep current?
Why keep current?
Connect with members
Help our members find you and connect with you for the care they need.
Get paid faster
Avoid claims payment delays when we have all your correct information on file.
Stay accurate
Ensure current and future members have the right information about your practice.
Tax identification number (TIN)
You don’t need to fill out a new application if you’re:
- An existing contracted provider updating your tax ID number (TIN)
- Adding another location under a different TIN
Just complete these steps:
- Send us a letter (on company letterhead) with details of the TIN change request. You can email us. Or you can fax us: 1-860-754-5435. Include your name and service location information.
- Include a copy of the new W-9, if applicable. If you’re contracted as a group, send a group W-9. Otherwise, just send an individual W-9.
After you send us your materials and information, we’ll process the change or contact you for more details.
If you don’t receive a confirmation email for the change, contact your Provider Relations representative. Check this Provider Relations representative territory map (PDF) to learn more.
Provider data information
You can choose from a few ways to update your provider information:
- Use the online form: Complete the form and follow the instructions to submit it.
- Complete the Practitioner information change form (PDF): Once complete, you can email it to us or fax it to 1-860-754-5435.
- Use the Medicaid Web Portal (MWP): This is also where you can find the Practitioner information change form. Just log in or register for the MWP, complete the form and send it to us by email or fax.
You can make updates to your provider information, including:
- New service locations for an existing contracted TIN
- Change of address, phone number, fax and office hours
- Specialty, hospital affiliations, board certifications and other details
You can learn more about Availity on the Provider Portal page.
Don’t have access to Availity? To update your information, you can also fill out and submit the Request Changes to Provider Data Submission Form.
If you’re a delegated, custom, National Advantage Program (NAP), rental network, dental or EyeMed provider, you can send your change request to your contracted group's administrator.
Taking part in the network
You can end or change your participation in the network
Depending on how you’re contracted with Aetna Better Health®, we’ll either end your individual contract or your participation from a group agreement. You can contact your Provider Relations representative if you’re ending your contract for any of these reasons:
- Moving to a new state
- Changing your group participation within the same address
- Retiring
- Provider deceased
- No longer employed
You or the requestor will need to have this information ready:
- Requestor’s first and last name
- Requestor’s title (example: office manager)
- Requestor’s email address
- Provider’s first and last names, and middle initial
- Address (including city, state and ZIP code)
- TIN
- National provider identifier (NPI) number
- Aetna® provider ID number (if known)
- Termination effective date
- Reason for termination
If you need to contact the state, your Provider Relations representative will notify you and give you the contact information.
Questions?
You can call Provider Relations at 1-866-638-1232 (TTY: 711). We're here for you Monday through Friday, 8 AM to 5 PM.