Medical Mutual - Health Plans for Life

Enrollment

Thank you for your interest in becoming a network provider.

Providers in Ohio and Kentucky (Boone, Campbell, and Kenton Counties only)

Please complete and submit the Network Enrollment Form below. Once submitted, a representative will contact you to discuss your eligibility for the network. Once your eligibility has been confirmed, you will be forwarded the applicable network agreements.

The company’s receipt of your signed agreements does not guarantee participation in the company’s managed care networks.

Your participation is subject to your meeting the company’s credentialing requirements and acceptance of your application by a committee of network physicians.

See our privacy statement for more information about our policies.

Providers Outside of Ohio and Kentucky (Boone, Campbell, and Kenton Counties only)

Please contact Aetna to become a network provider in the Aetna Open Choice PPO Network.

Network Provider Enrollment Form

Fields marked with an asterisk (*) are required.

Network Provider Enrollment Information

  • *
  • *
    (ex. (123)456-7890)
  • *
  • *
  • *
  • *
    (ex. (123)456-7890)
  •   
  • *
  • *
  • *
  • *
  • *
  • *

This Medical Mutual website may contain links to other Internet sites (“Third Party Sites”) that are not maintained by or under the control of Medical Mutual. These links are provided solely for your convenience, and you access them at your own risk. Medical Mutual makes no warranties or representations about the contents of products, services or information offered in such Third Party Sites. Consequently, Medical Mutual is not and cannot be held responsible for the accuracy, copyright compliance, legality or decency of material contained in Third Party Sites linked to this Medical Mutual website.

© 2019 Medical Mutual®