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Hospital credentialing

What does the Aetna hospital credentialing process involve?

Our credentialing policy and/or business participation requirements are part of our contract with participating hospitals. These hospitals must have a current license and accreditation from The Joint Commission. If The Joint Commission doesn’t accredit the hospital, it must be accredited by one of the following:

• The American Osteopathic Association (AOA)
• Det Norske Veritas Healthcare (DNV)
• An accrediting entity that Aetna policy and/or business participation requirements, or state/regulatory standards deem appropriate

According to our contract, participating hospitals must:

• Tell us about any material changes of licensure or accreditation status
• Keep enough malpractice and general liability insurance or self-insurance
• Provide evidence of such insurance upon request

Though the criteria may vary according to hospital type, in general, we require hospitals to:

• Show evidence of accreditation from a recognized accrediting agency for services and sites where they treat members
• Provide evidence of good standing with state and federal regulatory bodies
• Supply evidence that the provider is Medicare-certified or approved for certification when part of a Medicare market
• Have current professional liability insurance in adequate amounts, as we specify

Some of the specific information we collect includes:

Hospital name: The hospital self-reports its name on the first questionnaire. We update the questionnaire at least every three years or more often, according to state or federal requirements. It’s also part of our continuing contract information.

Accreditations: Hospitals must:

• Send a letter or certificate of accreditation from an accrediting agency that we recognize for services and sites where they treat members
• Show evidence of good standing with state and federal regulatory bodies
• Show a letter of certification or approval for certification from the Centers for Medicare & Medicaid Services

Our recognized accrediting agencies include:

• The Joint Commission (TJC)
• The American Osteopathic Association (AOA)
• Det Norske Veritas Healthcare (DNV)

We check accreditation when we first credential the hospital, and every three years thereafter. Not all hospitals may be accredited. Please check the current accreditation status by visiting:

• The Joint Commission
• AOA
• DNV

Location and Phone Number: The hospital reports its location and phone number on the initial questionnaire. We update the questionnaire every three years, and is part of the hospital contract.