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Join our network form

Thank you for your interest in participating as an Aetna Better Health® of Illinois provider.

Provider intake questions

Please answer these questions in order for us to have a better understanding of what services you provide and your location, as well as other pertinent information that’s needed for the contracting process. 

 

*Select contract type
 

If you are adding a new practitioner to an existing group, please email the Provider Relations team. 

 

Provider information

Include the official company name and, if you use one, the "doing business as" (DBA) name.
*Are you a part of a medical group?
Please follow this format: XX-XXXXXXX
Your National Provider Identifier number
If you do not have a Medicaid number, put NA.
Example: 12345

 

Primary contact person 

Would you like to receive emails from Aetna Better Health of Illinois?
 

Have any questions?

 

If you’re in need of additional information, please contact Aetna Better Health of Illinois at 1-866-329-4701 (TTY: 711).

 

*This is a required field.  

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