Aetna's logo Aetna Dental Home.Aetna Dental FAQs. Email Us


.Members and Consumers.|.Employers.|.Producers

Aetna Dental Networks
Small BoxInformation About Aetna Dental Networks
Small BoxRequest an Application To Join
Claim Resources
Small BoxDownload Claim Form
Small BoxClaim Documentation Guidelines
Small BoxTips for Submitting Claims and Encounters to Aetna
Small BoxOrthodontic Claim Tips
Small BoxUnderstanding Aetna Oral Surgery Benefits
Small BoxUnderstanding Explanation of Benefits (EOB)
Small BoxPaper Claim Tips
Small BoxGet Paid Directly with AutoDebit
Small BoxSalzmann Evaluation Form
Electronic Services banner
Small BoxAetna Payer IDs
Small BoxInformation About Electronic Services
Small BoxNational Provider Identifier (NPI)
Small BoxElectronic Attachments
Small BoxHelp With Electronic Transactions
Small BoxElectronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT)
Small BoxAetna Voice Advantage (SM)
Educational Resources
Small BoxReminder: Annual Required Medicare Compliance Training
Small BoxPractice-Management Coach
Small BoxLinking Dental Care to Overall Health
Small BoxEducational Site for Your Patients
Small BoxPlan for Your Health
(A Site for Your Patients)
Agreement With Dentists
Small BoxOur Commitment to the Dental Community
Other Helpful Tools
Small BoxDocFind® Provider Directory
Small BoxTelephone Numbers and Addresses
Small BoxSpanish for the Dental Office
Aetna Polices yellow bar
Small BoxAppeals Policy
Small BoxDental Clinical Policy Bulletins
Real-Time Eligibility

.Background .
.Real-Time Eligibility Transaction.
.Transaction Outcomes .

The electronic eligibility transaction was developed to enable dentists to request member eligibility status via electronic data interchange (EDI). Some highlights of the electronic eligibility transaction are:

  • Available for ALL Aetna dental benefit plans, including DMO, PPO and Indemnity Plans
  • Available 24 hours per day, seven days per week
  • Primary care and specialty dentists will have the capability to complete an eligibility transaction.

Back To Top

Real-Time Eligibility Transaction
The real-time eligibility benefit inquiry may be used for any Aetna Dental product (list includes Indemnity and PPO, DMO, Aetna Advantage Plus, Aetna Advantage Dental, Basic Dental, Family Preventive, Discount Dental and Pediatric Direct Access). The inquiry will be based on the member’s information and an American Dental Association (ADA) CDT-2005 procedure code. Inquiries can also be made on the above products with an “Aetna HealthFund”.

The eligibility transaction requires the Employee’s Social Security number or member ID and patient date of birth to perform an eligibility search. For members with an HMO rider product, only the member ID is required.

Back To Top

Transaction Outcomes
1. Error Response
When a real-time benefit eligibility transaction is unsuccessful, the provider will receive an error text message.

2. Patient and Plan Benefit Response
Below is a complete list of information that can be returned:

  • Payer Information – name and ID
  • Requesting provider name and number with associated information
  • Subscriber/patient information:
         SSN or member ID
         Group name/number and/or plan name/plan number
         Insurer name, address
         Date of birth
         Facility name and address (claim office)
         Plan begin date
         Service date (date inquiry is made)
  • Procedure code
  • Active coverage
  • Coverage level
  • Insurance type
  • Detailed financials, as applicable:
         Amount remaining

Back To Top

Copyright 2001-2015 Aetna Inc. .

Web Privacy Statement.Legal Statement.Privacy Notices.Member Disclosure