About Aetna
Aetna, now a subsidiary of CVS Health, is the third largest commercial health insurer in the United States with approximately 12% market share. The company provides commercial, Medicare Advantage, and Medicaid coverage to over 22 million members nationwide. Aetna operates across all 50 states and is widely contracted across all major specialty types.
How fast does Aetna pay?
Aetna typically processes clean claims within 30 days. Specialty and procedural claims requiring clinical review can extend to 45 to 60 days. Behavioral health claims are processed separately through Aetna Behavioral Health and may take 30 to 45 days.
Common denial and billing issues.
- Claim submitted to incorrect Aetna entity (commercial, Medicare, Medicaid)
- Missing referring provider information on specialist claims
- Place of service code mismatches between facility and professional claims
- Timely filing violations on secondary claims
- Medical necessity denials on diagnostic imaging
- Pre-certification number missing or invalid
Prior authorization requirements.
Aetna requires prior authorization for inpatient services, select surgical procedures, advanced imaging, home health, and specialty medications. Authorizations are managed through Aetna's provider portal. Aetna has reduced its prior authorization list in some states in response to regulatory changes.
How Copay works with Aetna.
Aetna commercial claims are purchased based on actual reimbursement performance data specific to your Aetna contract, procedure, and specialty combination. Copay's ENR model accounts for Aetna's plan-level reimbursement variations across commercial, open access, and network-tiered products.
Stop waiting on Aetna.
Eligible claims are purchased and funded the next business day.