Insurance regulations by state

Timely payment and grievance law for providers (PDF)

• California Assembly Bill 1936 maternal mental heath screening (PDF)
• HMO dispute resolution policy (PDF)
• Nondiscrimination notice (PDF)
• Provider disclosure form (PDF)

• Colorado Regulation 425 provider credentialing by carriers (PDF)

Policy changes

For important information that may affect your payment, compensation or administrative procedures, see the “Important policy information” section of the quarterly OfficeLink Updates newsletter.

Language services

We provide free aids and services to people with disabilities and free language services to people whose primary language is not English. This includes language interpreters and plan details written in other languages. If your patient needs these services, call the number on their member ID card.

Notice regarding the use of artificial intelligence (AI) in utilization management

We may use AI to help process claims. AI may be used to auto-approve claims that meet required criteria and to improve client services. We never use AI to deny care for medical reasons. Adverse decisions based on medical necessity are only made by licensed health care professionals.

Connecticut regulatory amendment to Aetna provider agreements (PDF)

Behavioral health coverage requirements

We’re required to comply with various federal and state behavioral health coverage requirements. This includes, but isn’t limited to, the Affordable Care Act essential health benefits requirements, the Mental Health Addition Equity Act and Florida Statutes § 627.668 ST § 627.669. If you have questions about your behavioral health coverage provided under these laws, call us at 1-800-424-4047 (TTY: 711).

You can also:

• Reach out to the Florida Division of Consumer Services with questions at 1-877-MY-FL-CFO (1-877-693-5236) or visit their website to learn how to contact consumer services.

• Get help to file a consumer complaint with the Florida Division of Consumer Services on their website.

Provider training

Dual-eligible special needs plans model of care (D-SNP MOC) provider training (PDF)

Reimbursement update for behavioral health network providers

Starting January 1, 2027, your reimbursement rate for mental health and substance use disorder services may differ from your contracted rate under Illinois HB 1085, 215 ILCS 5/370c.4. This applies to services for Aetna® members covered by applicable health plans amended, delivered, issued or renewed on or after January 1, 2027.

We’re required to comply with Illinois state law, which allows external stakeholders to request training on behavioral health medical necessity criteria. To request this training, email our team.

Uniform Electronic Provider Directory Information form now available

The Illinois Department of Insurance (DOI) has adopted a Uniform Electronic Provider Directory Information form (Uniform Directory template) after receiving task force feedback.

Starting July 1, 2026:

• Providers joining, already participating in or leaving a network must use this form to submit directory information to insurers.

• Insurers must provide and accept the form and use the submitted information to update their directories. By law, insurers can no longer accept paper or fax submissions of provider directory information from participating providers.

Provider directories must be verified at least every 90 days. You’re required to:

• Respond to verification requests.

• Notify insurers of directory changes within 10 business days.

When verifying your demographic information, you only need to complete fields that have changed, as long as you attest that the rest of your information remains accurate.

Uniform directory template (PDF)

Contracting team: contact information

Thanks for reaching out to Aetna®.

For contract negotiation requests, email the Maine provider contracting team with your name and email address.

You can also call the Maine contracting team, for contracting questions only, at 1-207-791-7909 (TTY:711)

Pain management access plan

This plan is designed to reduce reliance on opioids and promote safe, effective pain treatment.

Maine pain management access plan (PDF)

• HMO-based plans (PDF)
• Prior authorization bulletin (PDF)
• Behavioral health for children and adolescents (BHCA) provider training (PDF)
  
• Behavioral health for children and adolescents (BHCA) provider training – questions and answers (PDF)

To download the MDHHS-573 Nonopioid Directive form, visit the Michigan opioid resources page and look under “Additional Resources.”

Electronic prior authorization requirements

Michigan amended its current utilization review law. Starting June 1, 2023, you need to submit all prior authorizations requests electronically. You can submit these requests through Availity. It will help you stay compliant and you can take advantage of many other benefits.

To register for Availity, you’ll need your physical address, billing address, tax ID, NPI and primary specialty. Already registered? Log in to Availity.

Precertification

In some cases, we’ll pay for care only if we’ve approved it before the member receives it. The Aetna® primary care provider (PCP) or network provider is responsible for getting this approval for covered in-network services.

You can find the Aetna precertification list on our provider website. You can also call Member Services to find services that require prior authorization.

We cover medically necessary treatment, procedures, therapies and diagnostic ambulatory and inpatient services. We may require you to submit clinical information to confirm that the requested care is medically necessary. If we don’t receive clinical information, or the information we receive isn’t enough to approve the authorization request, we’ll issue an administrative denial.

Check our precertification lists

Administrative denials for lack of clinical information

If we haven’t approved an authorization request because we don’t have enough clinical information to determine whether the care is medically necessary, and an appeal hasn’t been filed, we’ll review the request along with additional information as follows:

Precertification requests

• When received within 14 calendar days of the letter of noncertification, the services haven’t started and a peer-to-peer review hasn’t been completed: We’ll review the additional information with the original request. We’ll make a decision based on all information received at that time.
• When received within 14 calendar days of the letter of noncertification and peer-to-peer review has been completed: We’ll review the additional information along with the original submission as a new precertification request.
• When received more than 14 days from the date of the denial letter for services that have not yet started, and the missing information is received within 6 months of the date of the denial letter: We'll review the additional information along with the original submission as a new precertification request.

Concurrent review requests

• While the member is receiving ongoing concurrent inpatient or ambulatory services, or within five 5 days of termination of these services: We'll review the additional information along with the original submission and make a determination.
• After the member has been discharged from an acute inpatient event and an adverse determination was issued due to lack of clinical information to support medical necessity, and clinical information is received within 5 business days of hospital discharge but prior to peer-to-peer review or appeal request: We’ll review the additional information along with the original submission and provide a determination.

Learn more about concurrent review

We will review the request and provide a determination within Missouri statutory time frames.

Montana non-contracted provider lien (PDF)

Notice regarding the use of artificial intelligence (AI) in utilization management

We may use AI to help process claims. AI may be used to auto-approve claims that meet required criteria and to improve client services. We never use AI to deny care for medical reasons. Adverse decisions based on medical necessity are only made by licensed health care professionals.

Claims practices and resolution annual provider notice (PDF)

• Continuation of benefits due to total disability form (PDF)
• Adult medical attending physician statement – for medical conditions for subscriber and dependents over the age of 18 (PDF)
• Provider appeal procedure (PDF)

• New York evaluation and management program claim and code review (PDF)
• Company affiliates list (PDF)
• New York dispute resolution for emergency services and surprise bills (PDF)

Oregon confidential communication requests for enrollees (PDF)

Rhode Island notice of complaint, appeals and grievance process (PDF)

• Texas telemedicine, teledentistry and telehealth services reimbursement policy
• Texas preauthorization information

Notice regarding the use of artificial intelligence (AI) in utilization management

We may use AI to help process claims. AI may be used to auto-approve claims that meet required criteria and to improve client services. We never use AI to deny care for medical reasons. Adverse decisions based on medical necessity are only made by licensed health care professionals.

• Washington extenuating circumstances policy (PDF)
• Washington utilization management and exception process (PDF)