Policies & Guidelines

Find clinical and pharmacy policy bulletins and Aetna healthcare policy and guidelines. Get information about eligibility, precertification and more.

Health Care Policies & Guidelines

• Clinical policy bulletins 

Determining Insurance Eligibility
Find out if a patient is eligible for coverage.

• Precertification
• Concurrent Review
• Retrospective Review

Billing, Payment and Reimbursement
Here are the forms to submit claim information for electronic billing and payment. Some state guidelines apply.

Insurance Dispute and Appeal Process
These resources can help you solve claim disputes and appeals.

• Frequently Asked Questions 
• State Regulations 
• Reference Guide 

State-specific Information

• Amendment to Colorado provider contracts  (PDF, 20 KB)
• CA - Provider Disclosure Form  (PDF, 216 KB)
• New Jersey-New claims review process for observation room charges  (PDF, 188 KB)
• New York Regulatory Amendment  (PDF, 51 KB)
• New York Affiliates List  (PDF, 12 KB)
• State of California—New Timely Access Regulations  (PDF, 34 KB)

Frequently Used Documents

• Rx Medical Exception/Precertification