Claims & Administration

Administrative tasks can eat up a lot of precious staff time. Our electronic tools make it easier and faster to:

• Check a member's eligibility and benefits  (PDF)
• Request an estimate - find out what Aetna will pay and how much your patients will owe before a scheduled visit or procedure
• Make referral requests and review Referral Guidelines 
• Submit claims
• Get claim payment information
• Fee Schedule Tool

CAQH CORE Phase II Accreditation

Aetna is pleased to announce that is has achieved CAQH® Committee on Operating Rules for Information Exchange (CORE® ) Phase II Certification.  The CORE Seal was awarded after successfully completing CORE certification testing - a process ensuring that healthcare organizations can electronically exchange or access patient information according to the CORE rules.  Visit www.caqh.org for more information.

Trade Associations

Aetna is pleased to have relationships with the following trade associations. Please visit their websites for more information.

• The American Medical Association: www.ama-assn.org
• The Healthcare Billing & Management Association: www.hbma.org
• The Workgroup for Electronic Data Interchange: www.wedi.org

Get started:

1. Free of charge through our secure provider website

2. Free of charge using EDI Connect^SM (for the technically savvy)  (PDF, 168 KB)

 
Or contact one of our clearinghouse vendors. 

Claims Transactions
We offer electronic transactions so you can submit claims and check claim status. 

Billing, Payment & Reimbursement
Get claim payment information online through electronic remittance advice, electronic funds transfer, electronic explanation of benefits, view reimbursement guidelines and how we pay out-of-network benefits.

If you're already a member of our Aetna network

Register with our secure website to perform free real-time transactions, set security controls, access multiple health plans and services, use clinical-decision support tools, and more.

New Jersey Providers - Information Concerning Process for Precertification and Claims Submissions:

• Radiology and Imaging Services
• Physical Therapy and Occupational Therapy Services
• Chiropractic Services 

New York Providers - Information Concerning Process for Precertification and Claims Submissions:

• Radiology and Imaging Services