Submitting Orthodontic Claims

Please include all of the following information with your first paper or electronic claim submission. This will help us determine benefits quickly and should eliminate the need for additional claims submissions.

• Banding date
• Number of months of treatment
• Assignment of benefits information
• ADA code
• Total case fee
• Primary insurance provider explanation of benefits (if coordination of benefits is necessary)
• Prior insurance carrier information, including deductible, coinsurance/copay, maximum and amount paid to date (if patient is continuing active treatment)

Please follow these additional tips for submitting orthodontic claims to Aetna:

• All orthodontic claims can be submitted electronically.
• Orthodontic claims do not require clinical attachments or diagnostic casts.
• Send only Initial Claim for Orthodontic Treatment Plans — Our system has been enhanced to automatically set up a regular payment schedule for most orthodontic treatment plans. Once we receive the initial claim indicating the banding date, total case fee, length of treatment and all other required claim details, our system will automatically release the appropriate monthly/quarterly installment payment for the member’s treatment plan, as long as he/she remains eligible for benefits.