Electronic Transaction Tools
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.
Claims submission and claims status
Electronic remittance advice (ERA) and electronic funds transfer (EFT)
ERA is a safe and convenient alternative to paper reports.
Enroll in ERA online through CAQH
EFT lets us send claims payments directly to your bank account.
Patient eligibility and benefits
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
Where to find eligibility and benefits information
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 two ways:
- Submit patient referrals through our secure provider website
- Submit patient referrals through one of our vendors
Learn more about our referral policy in the Office Manual for Health Care Professionals
Understanding electronic referrals
*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.
Precertification
Certain services require precertification. Submit requests electronically in one of two ways:
- Submit precertiication requests through our secure provider website
- Submit precertification requests through one of our vendors
Prescribing & Specialty Pharmacy
E-prescribing
Get started with e-prescribing
Electronic prior authorization
We offer two options for electronic prior authorization of specialty drugs:
- Use our secure provider website for electronic prior authorization
- Use CoverMyMeds for electronic prior authorization
Aetna partners with CoverMyMeds 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 CoverMyMeds, call 1-866-452-5017 (Monday through Friday, 8 am to 11 pm; Saturday 8 am to 3 pm ET).
Automated provider support
If you’d rather call us than go online, 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 access Aetna Voice Advantage by calling our Provider Service telephone numbers:
For HMO plans and Medicare Advantage plans, call 1-800-624-0756.
For all other plans, call 1-888-MDAetna (1-888-632-3862).
