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Dental Electronic Claim and Encounter Submission
Overview

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.Required Information.
.Claim Status Messages.
.Information Available at www.aetnadental.com.
.OHIO Dentists: New Ohio Law for Electronic Claims and Payment.
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As part of Aetna's commitment to streamlining administrative tasks for health care providers, Aetna offers an electronic batch dental claim submission transaction. This transaction can also be used to submit dental encounters.

Highlights of the electronic dental claim submission transaction are as follows:

  • Reduction in paper administration
  • No need to print the claim, fold and put in an envelope
  • Expedited receipt of claims
  • No time delay with claims in the mail
  • Claim receipt acknowledgements are sent when Aetna receives the claim(s)
  • Expedited return of claim determinations
Required Information
For any claim submission, it is imperative that the correct information be included in the correct format. Insufficient information may cause rejection of a claim.

With electronic dental claim submissions, you learn of errors promptly and can correct them more quickly than with paper claims.

Patient identification information (from ID card or equivalent):

  • Subscriber or member last name, first name or initial, middle initial (if available)
  • If multiple names are listed on the card, use the first listed name as the subscriber name.
  • ID number — Most Aetna ID numbers are either eight characters (with numbers and letters), nine characters (numbers only), or 10 characters (a W followed by nine numbers; please include the W as well as the nine numbers).
  • On some ID cards an additional two numbers may be present as a family member number. The family member number may be sent following the ID number, but is not required.
  • Hyphens and/or spaces may appear within the ID number as printed on the ID card, and may be sent, but are not required.
  • Please see attachment A for information on Aetna's family ID card.

If an identification card is not available, covered individuals can obtain and print equivalent information from the Aetna Navigator secure website at www.aetna.com. Dental offices can use Aetna's eligibility inquiry transaction, available from the secure website for dentists at www.aetnadental.com. DMO primary care dentists can also access their eligibility roster information through these websites.

If ID card or equivalent information is not available, use the employee/subscriber or member's first and last name and, where permitted by state law, the social security number.

The following patient information is also required:

  • Patient's first and last name (if different than subscriber/member name)
  • Patient's date of birth
  • Patient's relationship to the employee/subscriber (indicating "unknown" is acceptable when this information is not available)

Required provider information:

  • Billing provider identification number (e.g., TIN/SSN)
  • If different from billing provider, also send rendering/servicing provider name and address.
  • Billing provider name and address

If a five-digit payer ID number is required to indicate the destination of the claim, use 60054.

Please note that CDT-2005 codes (five-position codes starting with the letter "D") are required by HIPAA standards.

Other required information:

This varies according to the specifics of the submitted claim. Please see the HIPAA transaction standards and information on industry standards for billing.

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

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Claim Status Messages
Aetna automatically returns claim status messages to the submitter upon receipt of an electronic claim. These indicate the Aetna acceptance or rejection of a claim. Claims receiving a rejection do not create any other response or output (i.e. Aetna will not create any explanation of payments, explanation of benefits or remittance advices for these claims). For some claims, Aetna will return additional messages indicating the status of the claim.

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Information Available at www.aetnadental.com
Aetna's secure website for dentists gives you access to many services and self-service options. With the click of a mouse, you can submit a claim or review patient eligibility. The site is available 24 hours a day, seven days a week, giving you the information you need, when you need it.

Using the website allows you to quickly and easily:

  • Check on the status of a claim
  • Access DocFind®, Aetna's online referral directory — This searchable, online directory lists dentists and other health care professionals participating in Aetna's networks, along with their provider identification numbers (PINs).
  • View patient eligibility information
  • Request a dental provider application
  • Access continuing education credits sponsored through the University of Pennsylvania
  • Request Aetna Dental patient brochures
  • Access information on electronic attachments

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OHIO Dentists: New Ohio Law for Electronic Claims and Payment
If you submit claims electronically, Ohio law now requires you to either enroll in EFT or sign an opt-out form stating you do not wish to enroll in EFT. Read more.

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