This information (other than the National Health Insurer Report card results) has been provided to the AMA by Aetna and is current as of March 2014.
Certain functions listed below are only on Aetna's secure provider website on NaviNet® and are limited to contracted providers. Registration is required.
Payment rules - Information is available through NaviNet.
Please note that Aetna does not list the following information online:
- Patient assignment of benefits to a non-participating physician
- Assistant Surgeons: CPT code list not provided
- Multiple Procedure Reduction Logic
The Payment Estimator is an online tool which supplies a real-time estimate of what Aetna will pay a participating provider, as well as an estimate of how much money the patient will owe for services rendered.
View this guide to determine when and where to submit appeals.
Available electronic health care transactions
The following transactions are available through NaviNet and may also be available through other electronic vendors.
- Claim status inquiry
- Claim submission - only professional claims (CMS-1500) are available through NaviNet
- Electronic Remittance Advice
- Eligibility and benefits inquiry - Aetna participates in COB Smart™, a CAQH® Solution. Eligibility responses will state whether patients belong to more than one insurance plan and which one is primary.
- Precertification Submission and Inquiry
- Referral Submission and Inquiry
Information is available through NaviNet. Those with links below provide some information that is accessible prior to logging into NaviNet.
- Capitation reports
- Care considerations
- Claim reconsideration
- Clinical & Payment Policy Code Lookup
- Code editing tool
- DocFind® Provider Directory
- EFT E-mail notification
- Electronic Remittance Advice, Electronic Funds Transfer & Electronic Explanation of Benefits
- ERA/EFT enrollment form
- EFT only enrollment form - Aetna offers automated EFT enrollment through CAQH's online EFT Enrollment utility. New user registration is required. For more information and to access, visit the utility website
- EFT/ERA Reference Guide
- HMO Rosters/Capitation Reports
- Managed Choice/Elect Choice Rosters
- Online EOBs
- Personal Health Records
- Provider Data Maintenance
- Rejected/Returned Claim interactive resource and guide
- Update Aetna Provider Profiles
- 5010, ICD-10, & NPI topics and related links
- Using your NPI in HIPAA standard electronic transactions
- Electronic Claims Submission (EDI)
Learn about the EDI transactions that are available.
- Information on submitting secondary claims electronically
- List of Electronic Transaction Vendors who handle claims, ERA & real-time transactions
Aetna "Aexcel" Program
A description and analysis of Aetna's "Aexcel" program, measured against AMA principles regarding pay-for-performance programs.
National Health Insurer Report Card
Review the NHIRC for this year and past years to see how Aetna stacks up on a variety of critical metrics.
Health Insurer Financial Information:
Health insurer financials
The AMA has compiled a resource that highlights health insurer SEC filing data since 2006. This resource provides information based on company filings for the seven largest national publicly traded health insurers: Aetna, CIGNA, Coventry, Health Net, Humana, UnitedHealthcare and WellPoint/Anthem.
Health insurer state fines
The AMA has compiled a resource that lists the fines health insurers have incurred in each state and the reasons for the fines. This resource underscores the importance of reporting unfair payer practices.
Health insurer CEO compensation
The AMA has compiled a resource that highlights health insurer SEC filing data, including CEO compensation since 2006. This resource provides information based on company filings for the seven largest national publicly traded health insurers: Aetna, CIGNA, Coventry, Health Net, Humana, UnitedHealthcare and WellPoint/Anthem.