Aetna requires in-network providers to submit claims within 90 days of the date of service. Out-of-network providers have 180 days. Electronic submission via Availity or a certified clearinghouse is required for all professional and institutional claims.
Day 1: Verify eligibility and benefits before service. Day of service: Collect copay, verify member ID. Days 1-3 post-service: Submit clean claim electronically. Days 4-14: Automated adjudication for clean claims. Days 15-30: Payment processed. Days 31-90: Final filing window for in-network claims.
| CARC Code | Reason | Primary Cause | Fix |
|---|---|---|---|
| CO-4 | Procedure code inconsistent with modifier | Coding mismatch on claim | Run NCCI edits before submission |
| CO-22 | Coordination of benefits | Other insurance not identified | Verify COB status at eligibility check |
| CO-29 | Timely filing | Claim submitted after 90 days | Submit within 30 days for best results |
Appeal denied claims within 180 days of the denial date. Submit via the Aetna provider portal with supporting documentation. Include the original claim, EOB, and corrected information. Standard appeal response: 30 days.
Aetna strongly prefers electronic claims. Paper claims are accepted only from providers without electronic capability, and processing takes 30-45 days versus 14-21 for electronic submissions.
Aetna accepts claims through Availity (preferred), Change Healthcare, Trizetto, and other certified EDI clearinghouses. Check Aetna's provider portal for the current list of approved trading partners.
Submit a replacement claim (frequency code 7 on the CMS-1500 or bill type xx7 on UB-04) with the original claim number referenced. Corrected claims must be filed within 90 days of the original remittance date.
Altair validates every claim field against Aetna's requirements before submission.