Electronic transaction tools

See our page about electronic claims

Understanding electronic claims and claims status transactions (PDF)

Where to find claims information (PDF)

ERA is a safe and convenient alternative to paper reports.

Enroll in ERA online through Payer Enrollment Services

EFT lets us send claims payments directly to your bank account.

Enroll in EFT online through Payer Enrollment Services

See more details about ERA, EFT and electronic EOBs

Check patient eligibility and see patient copay, deductible and coinsurance amounts in one of two ways:

Check patient eligibility through our secure provider website

Check patient eligibility through one of our vendors

Understanding eligibility and benefits inquiry (PDF)

Where to find eligibility and benefits information (PDF)

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 two ways:

Submit patient referrals through our provider portal

Submit patient referrals through one of our vendors

Learn more about our referral policy in the Office Manual for Health Care Professionals

Electronic referral guide (PDF)

*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.

Certain services require precertification. Submit requests electronically in one of two ways:

Submit precertification requests through our provider portal

Submit precertification requests through one of our vendors

Electronic precertification guide (PDF)

See precertification lists or search by CPT code

Electronic prior authorization

Use our provider website for electronic prior authorization of specialty drugs through Novologix

Aetna partners with Novologix to offer free electronic prior authorization services for specialty drugs on Aetna’s National Precertification List. You can use this service for commercial and Medicare members for all health plans.

For questions about Novologix, call 1-866-378-3791 or send them an email