Electronic Claim FAQs

Submitting electronic claims and encounters

What are the correct payer IDs for Aetna claims and encounters?
Use 60054 for Aetna claims and 68246 for Aetna DMO^® plan encounters.
Effective January 2016 use 18014 for dental Medicare claims.

Can I submit all claims and encounters electronically?
You can submit all claims and encounters electronically. And you can submit encounters in the same format as claims.

Can I resubmit claims and encounters electronically?
You can resubmit all claims and encounters electronically. This is helpful if a claim is rejected through the vendor for missing or invalid information. Electronic claims reports indicate these rejects. And these can be corrected and resubmitted electronically. We check and reject exact duplicates of claims submitted electronically within 180 days of the original claim.

If the dentist is having a problem with electronic claims being rejected, who do they call?
Call the contact number on the claims status report from the EDI vendor.

Are primary payer Explanation of Benefits statements always required when Aetna is the secondary payer?
We don’t always require the statement of payment or rejection from the primary carrier. But we may sometimes need the actual document. We will request any documents if we need them.

What types of attachments are required for dental electronic claims?
Claims attachments are not always necessary. We encourage you to review our Claim Documentation Guidelines to determine which attachments, if any, are required. Or you can submit claims without attachments. We will request any attachments if needed. Or you can call our National Dentist Line at 1-800-451-7715.

Are attachments required for dental electronic encounters?
No. Encounter submissions do not require any attachments.

Can I send attachments electronically?
You can send attachments to us electronically through an attachment vendor, Change Healthcare, DentalXchange, NEA or Tesia. This service allows you to send X-rays, periodontal charts, intraoral pictures, etc. via the Internet for insurance carriers to view in support of electronic claims. For more information, contact the vendor directly.

For DMO specialty procedures, are copies of specialty referrals required along with my claim for payment?
We don’t need an actual copy of the referral. But specialists will need to indicate in the remarks field that a patient has been referred.

Can I submit orthodontic claims electronically?
Yes. You can submit orthodontic claims electronically for all products. Please note: Orthodontic claims do not routinely require models or X-rays.  Submitting Orthodontic Claim Tips

How can I submit a predetermination/pretreatment estimate electronically?
Submit the pretreatment estimate electronically simply by omitting the dates of service. This will reflect that the treatment has not been completed.

Can claims transactions be submitted without a CDT procedure code?
No. A valid CDT procedure code must be included and the code must support the tooth in question, if applicable. Claims and encounters submitted with missing or invalid procedure codes will be rejected.

Who should I contact if I have additional questions about electronic claims?
To help you determine who to contact, please use the following as a guide:

• If your claim is rejected at the vendor or clearinghouse level, contact your vendor.
• If your claim is rejected at the carrier/payer level, contact your vendor.
• If you have questions regarding claims handling (payment or denial), contact Aetna using the toll-free number listed on the remittance advice.