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Dental Electronic Claim And Encounter Submission
Frequently Asked Questions (FAQs)

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.Q. What are the correct payer IDs for Aetna claims and encounters?.
.Q. What claim transactions can be submitted electronically?.
.Q. Can electronic claims be resubmitted electronically? .
.Q. Can old claims be submitted electronically?.
.Q. If the provider is having a problem with electronic claims rejecting, who do they call?.
.Q. Are there any line, total or system limitations for charges on electronically submitted claims? .
.Q. Is there any limit on the number of service lines that can be submitted on electronic claims?.
.Q. Are primary payer explanations of benefits always required when Aetna is the secondary payer?.
.Q. What types of attachments are required for dental EDI claims?.
.Q. Can I send attachments electronically? .
.Q. For DMO specialty procedures, are copies of specialty referrals required along with my claim for payment?.
.Q. Can orthodontia claims be submitted electronically?.
.Q. How can I submit a pre-determination/pre-treatment estimate electronically?.
.Q. Can claim transactions be submitted without a CDT procedure code?.
.Q. Who should I contact if I have additional questions about electronic claims?.
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Q. What are the correct payer IDs for Aetna claims and encounters?
A. Use 60054 for Aetna claims, and 68246 for Aetna encounters.

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Q. What claim transactions can be submitted electronically?
A. All claims and encounters can be submitted electronically.

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Q. Can electronic claims be resubmitted electronically?
A. Yes, claims and encounters can be resubmitted electronically. This is especially beneficial if a claim is rejected through the vendor for missing or invalid information. Electronic claim reports indicate these rejects, which can be corrected and resubmitted electronically. Duplicate claim logic is in place to reject exact duplicates of claims submitted electronically within 180 days of the original claim (currently on ACAS and Aecclaims).

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Q. Can old claims be submitted electronically?
A. Claims that are past timely filing limitations, often referred to as “old claims,” can be submitted electronically. Timely filing limits will be enforced appropriately during claim processing.

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Q. If the provider is having a problem with electronic claims rejecting, who do they call?
A. Call the contact number on the claim status report from the EDI vendor.

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Q. Are there any line, total or system limitations for charges on electronically submitted claims?
A. There are no practical limitations. Technically, Aetna claim systems can handle submissions in excess of $1,000,000.

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Q. Is there any limit on the number of service lines that can be submitted on electronic claims?
A. Up to 50 lines can be submitted. Claims with a large number of lines may be split internally for processing.

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Q. Are primary payer explanations of benefits always required when Aetna is the secondary payer?
A. While Aetna does not always require the actual statement of payment or rejection from the primary carrier, we may sometimes need the actual document. Please provide the primary carrier’s payment amount in the remarks field, and if we require the actual document, we will request it. The HIPAA format allows for this information to be sent electronically as part of the claim.

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Q. What types of attachments are required for dental EDI claims?
While some claims require attachments, we encourage you to submit all claims electronically, without attachments. We will request additional information as it is needed. If we request an attachment after your claim has been submitted, we have a streamlined process to handle electronic claims with attachments.

To assist your office, a complete list of attachment requirements is available upon request.

Note: Encounter submissions do not require any attachments.

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Q. Can I send attachments electronically?
A. Electronic attachments can be sent in with your claim if you have a FastAttach account with National Electronic Attachment (NEA). This website lets you transmit X-rays, periodontal charts, intraoral pictures, etc., via the Internet for insurance carriers to view in support of electronic claims. If you have such an account, simply enter the image number(s) for the account in the NEA # field on the online single-claim form, or in the primary comments/insurance notes (or claim supplemental information field) for batch claims submitted through your practice management system.

If you don't have an electronic imaging account, please await a response from Aetna verifying that your claim requires an attachment. This method dramatically reduces the number of attachments that you send. Many insurance companies have reduced or eliminated the number of procedures requiring additional documentation.

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Q. For DMO specialty procedures, are copies of specialty referrals required along with my claim for payment?
A. While an actual copy of the referral is not required, specialists will need to indicate in the remarks field that a patient has been referred.

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Q. Can orthodontia claims be submitted electronically?
A. Yes, orthodontic claims should be submitted electronically for all products. Information concerning the treatment plan can be reflected in the remarks field. Aetna will contact you if additional information is required.

Note: Orthodontic claims do not routinely require models or X-rays.

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Q. How can I submit a pre-determination/pre-treatment estimate electronically?
A. Submit the pre-treatment estimate electronically simply by omitting the dates of service. This will reflect that the treatment has not been completed. Please follow the same procedures as outlined above for X-rays, charting and narratives. Aetna will contact the member or provider if additional information is required.

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Q. Can claim transactions be submitted without a CDT procedure code?
A. No, a valid CDT-2005 procedure code must be reflected and the code must support the tooth in question, if applicable. Claims and encounters submitted with missing or invalid procedure codes will be sent back to the provider.

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Q. Who should I contact if I have additional questions about electronic claims?
A. To assist you in determining whom to contact with questions on your electronic claims, please use the following as a guide:

  • If your claim is rejected at the vendor or clearinghouse level, contact your vendor.
  • If your claim is rejecting at the carrier/payer level, contact your vendor.
  • If you have questions regarding claim handling (payment or denial), contact Aetna using the toll-free number listed on the remittance advice and/or the number on the patient’s ID card.

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