Texas Insurance Regulation Preauthorization

For a detailed description of Aetna’s preauthorization process, please refer to our Member Handbook and Consumer Disclosures, which can be accessed from our website here.

For a current list of the health care services that Aetna requires preauthorization for and other relevant information about each of those services, please reference the following:

• Aetna’s current participating provider precertification list and the effective date of those requirements can be found  here.
• Supporting documentation needed to process precertification requests can be found under the “Medical Precertification” drop down on our website here. The Texas Department of Insurance (TDI) also provides additional forms that are optional to use.
• Applicable screening criteria used by Aetna when deciding to approve or deny a precertification request can be accessed here.
• Statistical information on approval/denial rates and other information will be forthcoming early 2020 once Aetna is able to gather and compile a complete calendar year of 2019 data.

*Please note, it is the participating provider’s responsibility to initiate the preauthorization request on behalf of the member.