Facility Intent to Credential Form 2026

1. Click ‘Get Form’ to open the Facility Intent to Credential Form in our editor.
2. Begin by entering the recipient's information at the top of the form, including Aetna and the fax number. Ensure accuracy for smooth communication.
3. Fill in your company name and today's date. This helps establish a clear timeline for your request.
4. Provide your contact details, including your name, email, and direct phone number. This is crucial for follow-up communications.
5. Complete the sections regarding NPI Number, Tax Identification Number, and Provider Legal Name. These are essential for credentialing purposes.
6. Indicate your facility type (e.g., Dialysis, SNF) and whether you are Medicare certified. This information is vital for Aetna’s review process.
7. Answer if you are a Behavioral Health Provider by selecting 'Yes' or 'No'.
8. In the Additional Information section, provide any relevant details that may assist in processing your request.
9. Once completed, review all entries for accuracy before submitting. Finally, return this form to Aetna by faxing it to 859-455-8650.

Start using our platform today to streamline your document editing and submission process!