Aetna Provider Portal

Aetna’s Provider Portal simplifies healthcare management by offering quick access to claims, eligibility, prior authorizations, and payment tools supporting efficient, secure provider operations.

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Aetna Provider Portal is a secure online platform designed to streamline administrative tasks for healthcare providers who work with Aetna. Through the portal, providers can verify patient eligibility, submit and track claims, access payment information, check authorization requirements, and manage referrals—all in one convenient location. The portal also offers up-to-date policy information, clinical guidelines, and helpful resources to support quality care and efficient practice management. With intuitive navigation and 24/7 access, the Aetna Provider Portal helps providers save time and focus more on patient care.

What information do I need to verify patient eligibility and benefits for Aetna Provider Portal?

• Log in to the Availity (or applicable) portal and select “Eligibility & Benefits Inquiry.”
• Enter the date of service (defaults to today if left blank).
• Input the patient’s member ID, excluding prefixes/suffixes, or use full name + DOB (MM/DD/YYYY).
• Include the provider’s NPI to ensure accurate coverage responses.

• Select the service type (e.g., office visit, inpatient stay) to view relevant benefits.
• Provide procedure or service codes (CPT/ADA/ICD-10) when checking specific benefits.
• Enter the patient’s group number or plan number from their ID card.

• Use the patient’s date of birth and gender if name/DOB search is needed.
• Select payer ID when prompted (e.g., 00002 for commercial/Medicare Aetna plans).
• Submit the request and review detailed results: active coverage, deductibles, copays, coinsurance, remaining benefits, plan limits, and digital ID card.