Electronic transaction tools for providers

Learn about different ways to submit electronic insurance claims to get paid sooner.

• Electronic claims overview
• Tips for successful electronic claim submissions (PDF)

ERA is a safe and convenient alternative to paper reports.

Enroll in ERA through Payer Enrollment Services

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

Enroll in EFT through Payer Enrollment Services

Learn more about ERA, EFT and electronic explanation of benefits (EOBs).

Electronic payment and remittance for providers

Our eligibility and benefits inquiry transaction helps providers quickly and securely verify patient eligibility through an electronic exchange of HIPAA-standardized data. This 24/7 service is available to all providers, even if you’re not in the Aetna® network.

• Check patient eligibility through our provider portal on Availity
• Check patient eligibility through one of our vendors

Our provider manuals can support you in providing care, managing your practice and working with us. You can also find information about Aetna policy guidelines.

Visit our provider manuals page

Certain services require prior authorization. These resources can help you manage the process.

To send electronic prior authorization requests:

• Send prior authorization requests through our provider portal on Availity
• Send prior authorization requests through one of our vendors

To check if we require prior authorization:

Check prior authorization lists or search by CPT code

Need help – or an overview of the process?

Electronic prior authorization and referral guide (PDF)

We work with Novologix to offer free electronic prior authorization services for specialty drugs on the Aetna® national precertification list. You can use this service for commercial and Medicare members for all health plans

You can use our provider portal on Availity® to request prior authorization.

Request prior authorization for specialty drugs through Novologix

Questions about Novologix? Call 1-866-378-3791 or email the Novologix help desk.

You can help keep costs down by referring your patients to specialists their plan covers. Timely referrals help avoid claim reviews so you can get paid sooner.

Our guidelines for patient referrals let us authorize:

• Exact procedure code referrals: These referrals use CPT codes other than 99499. A primary care provider (PCP) should use these referrals when a member needs care for a specific health reason. We only reimburse for procedure codes that match the codes on the referral.
• Consult and treat (C&T referrals): These referrals use CPT code 99499. In most areas, C&T referrals don’t need to include the specialists’ procedures. We pay specialists for performing associated covered services in an office setting based on current claim processing guidelines.

Things to keep in mind:

• If we receive a patient referral without a code: The referral will default to a C&T referral code (99499). Authorized procedures depend on the number of visits on the referral.
• If we receive a patient referral for a procedure that requires prior authorization: We’ll return these requests and ask you to resubmit the code(s) using the prior authorization process. In some instances, we’ll grant a "modified" response where C&T code 99499 replaces the rejected procedure code.

How to submit patient referrals

You can submit an electronic referral* in one of two ways:

• Submit patient referrals through our provider portal on Availity
• Submit patient referrals through one of our vendors

Need help – or want an overview of the process?

Electronic prior authorization and referral guide (PDF)

You can also learn more about our referral policy in our “Office manuals for health care professionals.” It’s on our provider manuals page. 

Visit our provider manuals page