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Aetna Better Health of Missouri 10 South Broadway, Suite 1200 St. Louis, MO 63102 AETNA BETTER HEALTH OF MISSOURI Practitioner Credentialing Application request form Thank you for your interest in
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It is a form used for practitioner credentialing application which is in an accessible pdf format.
Practitioners who are applying for credentialing are required to file this form.
The form can be filled out electronically by entering the required information in the accessible pdf fields.
The purpose of this form is to gather necessary information from practitioners applying for credentialing.
Information such as personal details, education and training history, work experience, certifications, and references must be reported on the form.
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Relevant keywords

Missouri Aetna Credentialing PCP practicioners Healthof aetnabetterhealth MO-15-04-69 CAQH SSN NPI III credentialed collaborative DOB varies substantially Practitioner Demographic discrepancy II Provider

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