Online tools for easy and convenient transactions
Use our secure online transaction tools to save time and money. They're quick and convenient. They can simplify many administrative tasks.
Electronic patient eligibility
Check patient eligibility and see patient copay, deductible and coinsurance amounts in one of three ways:
Electronic claim status
Check the status of your claims electronically in one of three ways:
Electronic patient referrals
Keep costs down by referring your patients to specialists who are covered by their plan. Timely referrals can also help avoid claims reviews later. Reviews can hold up payments.
Our guidelines for patient referrals allow us to authorize:
- Exact procedure code referrals – These are referrals submitted with code(s) other than 99499. Primary care physicians (PCPs) should use these referrals when a member needs care for a specific health reason. We will only reimburse for the procedure code(s) that matches the code(s) on the referral.
- C&T referrals – These are referrals submitted with CPT code 99499. In most areas, consult and treat (C&T) referrals do not need to include the specialists’ procedures. We will pay specialists for performing associated covered services in an office setting, according to current claims processing guidelines.
Referrals submitted without a procedure code will default to a C&T referral (99499). Authorized procedures are subject to the number of visits on the referral.
We do not accept procedure codes for services that require precertification. We will return such requests and ask you to resubmit the code(s) using the precertification process. In some instances, we will grant a "modified" response where C&T code 99499 replaces the rejected procedure code.
Submit an electronic referral in one of three ways:
Through our secure provider website
Learn more about our referral policy in the Office Manual for Health Care Professionals
*Our referral system recognizes when a specialty capitation arrangement may apply. As appropriate, we will substitute the "referred to" provider with a provider who is aligned to the capitation arrangement of the requesting provider. In these situations, we will issue a "modified" response.
Electronic precertification
Certain services require precertification. Submit requests electronically in one of three ways:
E-prescribing
Send a prescription instantly. It costs nothing and is easy to use. And it can help protect against medication errors. You can even prescribe from a mobile app for convenience.
Fast, easy patient payments
Money2SM for Health lets your patients pay their bills quickly in one place.
Patients use their Aetna secure member website and click the option to pay online. Then, funds will go from their account to yours.
Money2 for Health benefits you, too, with:
- Lower administrative costs
- No set-up fees*
- Easy, self-service tools (and training materials and support)
- Fewer patient billing questions
Register now for Money2 for Health
Or for more information, call us at 1-877-305-0942 or email us
*You pay a small fee when you receive payments.
Claim Submission and Claim Status
- Adjustment codes list for coordination of benefits (COB) claims
- Understanding electronic claims status transactions
- Understanding electronic claims submissions
- Helpful hints - electronic bulk encounters
- Helpful hints - electronic claims status transactions
- Helpful hints - electronic claims status inquiry
- Where to find claims information
Eligibility and Benefits Inquiry
Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT)
Provider Payment Estimator
Precertification
Electronic Referrals
Automated provider support
Aetna Voice Advantage® lets you check patient benefits, claim status and precertification requirements. We can fax the information to your office within minutes.
You can also call our Provider Service Center during regular business hours:
For HMO plans and Medicare Advantage plans, call 1-800-624-0756.
For all other plans, call 1-888-MDAetna (1-888-632-3862).
This material contains only a partial description of the Money2SM for Health program. Information is believed to be accurate as of the production date; however, it is subject to change. The Money2SM for Health program is administered by Citibank, N.A. Neither Aetna nor PayFlex directs, manages or controls the services provided by Citi and does not assume any responsibility or liability for the services Citi provides. Aetna and/or PayFlex may receive a fee from Citi. The program provides access to a payment service, and each member has sole financial responsibility for the patient responsibility portion of his or her claims.
Money2, the Money2 logo, and Powered by Citi are service marks of Citigroup Inc. Citi and Citi with Arc design are registered service marks of Citigroup Inc.
