Background 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.
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.
Requesting provider name and number with associated 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)