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Real-Time Eligibility
Frequently Asked Questions (FAQs)

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.Q. What Aetna Dental plans offer electronic eligibility information?.
.Q. What information will be returned on the eligibility inquiry request?.
.Q. What information must I supply on the eligibility inquiry request?.
.Q: When is the dependent date of birth required for an inquiry?.
.Q. What information is returned on a member's benefit information?.
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Q. What Aetna Dental plans offer electronic eligibility information?
A. The electronic eligibility transaction is available for all DMO, PPO and Indemnity Dental benefit plans. This includes DMO, Aetna Advantage Plus, Aetna Advantage Dental, Basic Dental, Family Preventative, Discount Dental, and Pediatric Direct Acces.

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Q. What information will be returned on the eligibility inquiry request?
A. Member benefit and demographic information is returned on eligibility inquiries. The information returned is based on the member information and procedure code that is submitted.

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Q. What information must I supply on the eligibility inquiry request?
A. 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.

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Q: When is the dependent date of birth required for an inquiry?
A: The dependent date of birth is required for all transactions

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Q. What information is returned on a member's benefit information?
A. The electronic eligibility transaction can return the patient and plan benefit response:

  • Payer information — name and ID
  • Requesting provider name and number with associated information
  • Subscriber/member information:
         SSN or member ID
         Group name/number and/or plan name/plan number
         Insurer name
         Date of birth
         Gender
         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
         Co-pay
         Deductible
         Coinsurance
         Exclusions
         Limitations
         Amount remaining

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