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Claim Status Inquiry

.Claim Status Inquiry Transaction Request.
.Claim Status Inquiry Transaction Response.

Highlights of the electronic Claim Status Inquiry transaction are:

  • Claims processing information is currently available for Aetna Dental products. Those products include: Indemnity, PPO, DMO, Aetna Advantage Plus, Aetna Advantage Dental, Basic Dental, Family Preventive, Discount Dental and Pediatric Direct Access.
  • Available for both paper and electronic claim submissions
  • Transaction is available Monday through Saturday 24 hours per day and on Sundays from noon until 4 a.m.
  • Minimal wait time
  • Decreased manual processes, such as telephone calls
  • Initial receipt or rejection of claims (i.e., a claims acceptance or rejection after Aetna’s initial validation of the information found on the claim)

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Claim Status Inquiry Transaction Request
The following elements capture all the information needed to find claims in Aetna’s files:

  • Member ID or Social Security number
  • Subscriber’s last name
  • Patient relationship to the employee
  • Patient first and last name
  • Patient date of birth
  • Patient gender
  • Provider billing tax identification number and/or provider PIN
  • Date of service range

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Claim Status Inquiry Transaction Response
A prompt electronic response will be returned with the following elements:

Claim level:

  • Claim number
  • Total charged amount
  • Statement from and through date
  • Status message
  • Amount paid to the provider
  • Claim adjudication date
  • Check number/EFT trace number

Line level:

  • Procedure code
  • Procedure code modifier
  • Units of service
  • Charged amount
  • Amount paid to the provider at the line level
  • Status codes at the line level
  • Line date(s) of service
  • Institutional revenue code

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