Electronic Claim Submission

Submitting dental claims electronically saves time. No more printing claims and sending by mail. Electronic claims are typically paid faster and have fewer rejections.

ClaimConnect™ (DentalXChange), a service of EDI Health Group, makes it easy to file claims and do other transactions. It's available at AetnaDental.com. Or you can submit claims through another vendor.

Fewer returned claims

Submitting claims and encounters electronically is efficient. And you're advised when there is missing or incorrect information.

Patient information

Use the patient's ID card (or equivalent) to identify the:

• Subscriber or member last name, first name or initial, middle initial (if available). If there are multiple names on the card, use the first listed name.
• ID number.
• Patient's details, including the:
  • First and last name (if different than subscriber/member name).
  • Date of birth.
  • Relationship to the member/subscriber. (Indicate "unknown" if this information is not available.)

  If the ID card is not available, the member can print one by logging in to the website. Or your office can use our eligibility tool. You'll find it on the secure site for dentists. Dental Maintenance Organization (DMO ® ) primary care dentists can also access their eligibility roster information through this website.
  

  Provider information

  Your claim also needs to include your:

  • Tax identification number (TIN/SSN)
  • National Provider Identifier (NPI)
  • Name and address

  If different from billing provider, also send rendering/servicing provider name, address and NPI.

  If you need the five-digit payer ID number to show the destination of the claim, use 60054 for Aetna claims, and 68246 for Aetna encounters.

  Use current CDT codes (five-position codes starting with the letter “D”) for each procedure.

  The claim may require other information. This varies according to the submitted claim. Please check with your vendor for specific questions.

  We also accept claims with zero dollars as the billed amount (encounters).

  Know a claim's status

  We automatically let you know whether we’ve accepted or rejected the claim. You may also receive other messages about a claim's status.

  Ohio law for electronic claims and payment

  If you submit claims electronically, Ohio law requires you to either enroll in EFT or sign an opt-out form stating you do not wish to enroll in EFT.

  Claim tips & guidelines

  Find useful suggestions for filing your claims and attachments.

  Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies (Aetna). Dental benefits and dental insurance plans are underwritten by Aetna Dental Inc., Aetna Dental of California Inc., and Aetna Health Inc. and/or Aetna Life Insurance Company (Aetna). In Texas by Aetna Dental Inc. and in Virginia, the DMO plan is known as the Dental Network Only plan (DNO). DNO in Virginia is not an HMO. To receive maximum benefits, members must choose a participating primary care dentist to coordinate their care with network providers. Each insurer has sole responsibility for its own products.

  Vendors are independent contractors and not employees or agents of Aetna or participating providers of Aetna. Aetna does not endorse any electronic connectivity tools and services provided by vendors. This information is subject to change without notice and does not constitute a guarantee by Aetna of any kind.