How to change your address or add a different location
 

• Send us a letter (on company letterhead) with details of the address change request. You can email us. Or you can fax us: 1-855-222-6621. 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.

How to update any other information

The best way to update other provider information is to use the Availity® Provider Portal.
 

Just log in or register and you can make updates to your provider information, including:
 

• New service locations for an existing contracted TIN
• Change of 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.

Availity Provider Portal
 

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.

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. Ending your contract requires 60 days’ notice. You can contact your network relations manager 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 network relations manager will notify you and give you the contact information.