Aetna Medicare at a glance
| Legal name | Aetna Medicare |
|---|---|
| Also known as | Aetna Medicare Advantage, Aetna Part D |
| Category | Medicare Advantage |
| Parent organization | CVS Health (Aetna) |
| 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 | ~3.6 million members |
| Provider resource entry point | https://www.aetna.com/health-care-professionals/medicare/medicare-resources.html |
| Provider phone | 1-800-624-0756 |
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 Medicare
Identify the Medicare product, participation status and controlling agreement. This registry has not established one Aetna Medicare initial-filing period.
| Submission type | Window |
|---|---|
| Initial claim reference | Medicare product and provider agreement specific |
| 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 |
This registry has not established a payer-specific appeal ladder for Aetna Medicare. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: Aetna Medicare provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Aetna Medicare
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 Medicare 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 Medicare. 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 Medicare
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Aetna Medicare 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
- The March 2026 nonparticipating Medicare PPO guide identifies claims 60054 and provider phone 1-800-624-0756. It does not certify every Aetna Medicare product or other transaction identifiers.
- Do not apply a New York state-supplement passage as a national Medicare filing rule; check product, participation status and controlling agreement.
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.
provider_phone, payer_ids.claims, electronic_claims_supported, timely_filing_days
Source comparison: 2026-09-18
Nonparticipating Medicare PPO guide supports claims 60054 and 800-624-0756. Does not state a 120-day deadline or establish other transaction IDs. Source locator: PDF page 2 Electronic claims submission; Provider Service Center. Document/version: March 2026 (03/26).
Primary source for provider_phone, payer_ids.claims, electronic_claims_supported, timely_filing_daystimely_filing_days
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_daystimely_filing_days
Source comparison: 2026-09-18
Current Medicare provider resource directory and the linked nonparticipating PPO guide; not a tested authenticated portal. Source locator: Plan basics; Group Medicare; Aetna Extended Service Area video transcript.
Primary source for timely_filing_days
Not checked in this pass: 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.
Sources used for this guide
Evaluate QuickIntell workflow fit for Aetna Medicare
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 Medicare; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Aetna Medicare; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Aetna Medicare before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Aetna Medicare
Where is the Aetna Medicare provider portal?
Use https://www.aetna.com/health-care-professionals/medicare/medicare-resources.html as a starting point for Aetna Medicare 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 Medicare?
Identify the Medicare product, participation status and controlling agreement. This registry has not established one Aetna Medicare initial-filing period.
What is the Aetna Medicare 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 Medicare accept electronic claims?
Verify Aetna Medicare 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 Medicare denial?
This registry has not established a payer-specific appeal ladder for Aetna Medicare. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do Aetna Medicare 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 Medicare provider phone number?
This registry lists 1-800-624-0756 as a contact reference for Aetna Medicare. Confirm the number and service scope against the member ID card and current product-specific directory; claims, eligibility and authorization inquiries may use different teams.
Automate workflows around Aetna Medicare 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 Medicare's current published documents before submission. CPT® is a registered trademark of the American Medical Association.