Aetna at a glance
| Legal name | Aetna Life Insurance Company |
|---|---|
| Also known as | Aetna Inc., Aetna Health |
| Category | Commercial |
| Parent organization | CVS Health |
| Claims payer ID | 60054 — registry reference; verify the member product, transaction and clearinghouse |
| Eligibility (270/271) payer ID | 60054 — registry reference; verify the member product, transaction and clearinghouse |
| ERA (835) payer ID | 60054 — registry reference; verify the member product, transaction and clearinghouse |
| NAIC company code | Not established in this registry |
| States covered | Nationwide (50 states) |
| Members covered | ~27 million members |
| Provider resource entry point | https://www.aetna.com/health-care-professionals.html |
| Provider phone | 1-888-632-38621-888-632-3862 is non-Medicare medical provider support. Medicare, dental and administrator-based plans use separate contacts. |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Aetna
Aetna's New York state supplement describes 120 days after service for initial claims, unless a more favorable agreement or a different legal requirement applies. This is not a national participating-provider deadline. Confirm the member's product, state and provider agreement before calculating the filing date.
| Submission type | Window |
|---|---|
| Initial claim reference | Plan and state specific; New York reference: 120 days |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
Reconsideration and appeal routes
- Provider reconsiderationFile within 180 days
General reconsideration window measured from the initial claim decision. State exceptions apply; some clinical, utilization-review and other disputes go directly to appeal.
- Appeal after reconsiderationFile within 60 days
Measured from the reconsideration decision, not the original service date. Direct-to-appeal disputes, Medicare non-contracted providers and state exceptions have separate requirements.
Source: Aetna provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Aetna
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify Aetna electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for Aetna. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for Aetna
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Aetna volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | 60054 — registry reference; verify the member product, transaction and clearinghouse |
| 270 / 271 eligibility | Listed in registry; verify current scope | 60054 — registry reference; verify the member product, transaction and clearinghouse |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | 60054 — registry reference; verify the member product, transaction and clearinghouse |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
What revenue cycle teams should verify before submitting claims
- Non-Medicare medical, Medicare, dental and administrator-based plans have distinct contact routes. Follow the member product and responsible payer/TPA.
- Aetna’s routing chart printed 1/17 distinguishes medical eligibility 00002/AETNA from claims 60054. That historical document is a verification lead, not approval of a current eligibility or ERA identifier.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
Initial filing deadline
Source comparison: 2026-09-06
The state supplement's New York section describes a 120-day initial-claim window, subject to more favorable agreements or different legal requirements. It does not establish one national deadline.
Primary source for initial filing deadlineProvider disputes and contact routing
Source comparison: 2026-09-06
Aetna describes reconsideration within 180 calendar days of the initial decision and appeal within 60 calendar days of the reconsideration decision. Some disputes bypass reconsideration. Its non-Medicare contact is 1-888-632-3862; Medicare uses 1-800-624-0756.
Primary source for provider disputes and contact routingState exceptions
Source comparison: 2026-09-06
Aetna lists state-specific exceptions for fully insured plans. Identify the state, product and dispute type before using its general filing standard.
Primary source for state exceptionstimely_filing_days, filing_rule
Source comparison: 2026-09-18
120-day text is in New York supplement with law/agreement exceptions, not a national medical/Medicare deadline. Source locator: Printed p 33/PDF page 33; New York claims submission section. Document/version: August 2026 per current provider-manual index; references accessed July 14, 2026.
Primary source for timely_filing_days, filing_ruleprovider_phone
Source comparison: 2026-09-18
Non-Medicare medical 888-632-3862, Medicare 800-624-0756, dental 800-451-7715; ASA/Meritain route to patient ID card, not generic Aetna phone. Source locator: Health care professionals: claims/benefits/contact and authorization categories.
Primary source for provider_phonepayer_ids.eligibility
Source comparison: 2026-09-18
Historical routing guide distinguishes claims 60054 and medical eligibility 00002/AETNA. Dental has its own rows. This older guide is a conflict lead, not current clearinghouse certification. Source locator: PDF page 2 product/transaction table. Document/version: Printed 1/17; copyright 2017. Search crawl recency is NOT publication recency..
Primary source for payer_ids.eligibility
Not checked in this pass: Enrollment totals; Every payer ID and transaction; Every state or employer contract; QuickIntell integration or customer outcomes; All fields outside these bounded findings, including exact legal entity/NAIC, current enrollment and geography; Product-complete initial, corrected, secondary and appeal rules, agreements, exceptions and effective dates; Every claims, eligibility, ERA and authorization transaction identifier; portal access is not capability certification; Current clinical criteria and prior-authorization code samples; QuickIntell integrations/outcomes and historical DataForSEO demand; Accountable whole-record editorial approval; no last_reviewed date was advanced.
Evaluate QuickIntell workflow fit for Aetna
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for Aetna; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Aetna; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Aetna before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Aetna
Where is the Aetna provider portal?
Use https://www.aetna.com/health-care-professionals.html as a starting point for Aetna provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for Aetna?
Aetna's New York state supplement describes 120 days after service for initial claims, unless a more favorable agreement or a different legal requirement applies. This is not a national participating-provider deadline. Confirm the member's product, state and provider agreement before calculating the filing date.
What is the Aetna payer ID?
Claims: 60054 — registry reference; verify the member product, transaction and clearinghouse. Eligibility (270/271): 60054 — registry reference; verify the member product, transaction and clearinghouse. ERA (835): 60054 — registry reference; verify the member product, transaction and clearinghouse. Do not substitute a claims ID for an unverified transaction ID. Check current source findings and the member ID card before submitting.
Does Aetna accept electronic claims?
Verify Aetna electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a Aetna denial?
Identify the product, state and reason for the decision before choosing a Aetna dispute route. The listed starting route is Provider reconsideration (File within 180 days). General reconsideration window measured from the initial claim decision. State exceptions apply; some clinical, utilization-review and other disputes go directly to appeal. Verify the controlling notice and exceptions; reconsideration, appeal and external review are not always a mandatory sequence.
How long do Aetna prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the Aetna provider phone number?
This registry lists 1-888-632-3862 as a contact reference for Aetna. 1-888-632-3862 is non-Medicare medical provider support. Medicare, dental and administrator-based plans use separate contacts.
Automate workflows around Aetna requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against Aetna's current published documents before submission. CPT® is a registered trademark of the American Medical Association.