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Bundled codes for maternity are deleted January 1, 2027Get ready for the change >>
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Coverage profile

Work Aetna across every published route

Use the current payer record to choose the right claim-status, eligibility, portal, phone, or appeals workflow. Substrate only marks routes that are published for this payer.

Claim status

EDI 276/277

The Substrate Claim Status Agent can check clearinghouse claim status for your practice with Aetna.

Supported

Eligibility

EDI 270/271

The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Aetna.

Available

Coordination of benefits

Real-time check

The Substrate Eligibility Agent can check coordination of benefits for other active coverage and primary or secondary order with Aetna. Results can be partial. Enrollment is not required for this check.

Available

Enhanced claim status

Availity ECS
Supported

Portal claim status

Browser automation

The Substrate Claim Status Agent can check claim status via the payer portal for Aetna.

Supported

Appeals agent

AI appeals workflow

The Substrate Appeals Agent can submit appeals for RFIs, medical record requests, downcoding reconsiderations, and more via the payer portal for Aetna.

Available

Substrate prior authorization catalog

1 source

Browse Aetna’s official prior authorization lists and lookups in Substrate’s catalog.

  • Plan scope
  • Original sources
  • Review dates
Open prior authorization catalog

Other aliases

Also known as

  • 10004
  • 10397
  • 4500
  • 60054
  • 60054MA
  • 60055
  • 6400
  • 953402799
  • Z95668
  • Aetna Affordable Health Choices (SM) SRC
  • Aetna Insurance Company
  • Aetna Medicare Advantage
  • Aetna Medicare Replacement
  • Bell Atlantic
  • Choice Plus (TRW)
  • CustomCare (Prudential)
  • EmoryCare (Prudential)
  • FlexCare
  • Florida Power and Light (Prudential)
  • Foreign Service Benefit Plan
  • Healthcare Alliance (Sears)
  • IBM Medical Plans
  • Innovation Aetna
  • Los Alamos Total Care (Prudential)
  • Mail Handlers Benefit Plan - MHBP
  • Marriott
  • MedConnection (Marriott)
  • Minneapolis Prudential
  • NEA Group Insurance (Prudential)
  • Pacific Gas and Electric (PG&E)

2027 maternity billing research

Review Aetna’s 2027 OB/GYN billing guidance, plan-specific updates and policy sources.

Confirmed 2027 guidance

Aetna has published 2027 maternity billing guidance. The billing page explains the applicable patients, transition conditions, and billing dates and links the source.

Policy Updated At
September 2026
Aetna 2027 OB/GYN billing page →

Payer policies

Aetna policies

The first 25 of 5,481 public policies Substrate tracks for Aetna, by title. Links open the payer's own document; check its current version before relying on it.

Search all 5,481 Aetna policies by CPT code, keyword or policy number →

Routing reference

Aetna payer IDs and operating states

Use the payer ID listed for the transaction you are submitting. Verify current routing and enrollment requirements with your clearinghouse.

Aetna payer name, operating states, and transaction-specific payer IDs
Payer nameAetnaSource: Substrate payer directory · data last changed
837P professional claims payer IDStedi60054Source: Stedi payer catalog · catalog dated · matched by payer ID
837I institutional claims payer IDStedi60054Source: Stedi payer catalog · catalog dated · matched by payer ID
835 ERA payer IDStedi60054Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID
270 eligibility payer IDStedi60054Source: Stedi payer catalog · catalog dated · matched by payer ID
270 eligibility payer IDAvaility60054Source: Availity payer catalog · catalog dated · matched by payer ID
276 claim status payer IDStedi60054Source: Stedi payer catalog · catalog dated · matched by payer ID
276 claim status payer IDAvaility60054Source: Availity payer catalog · catalog dated · matched by payer ID

Routing sources and verification

  • Substrate payer directoryPayer identity, aliases, operating states, and vendor IDs. Data last changed ; checked .Open payer website ↗
  • Stedi payer catalogMatched by payer ID; matched record: Aetna. Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi reference ↗
  • Availity payer catalogMatched by payer ID; matched record: AETNA INSURANCE COMPANY. Source dated .The attached API workbook supplies 270 and 276 payer IDs only. It does not supply 837P, 837I, or 835 IDs.Open current Availity reference ↗
  • United Clearinghouse payer catalogMatched by payer name; matched record: Aetna. The source did not provide a publication date.The attachment supplies payer names and states only; it does not contain transaction-specific payer IDs.Open current United Clearinghouse reference ↗

Clearinghouse payer IDs are transaction-specific and can change. Confirm the current payer list and the member’s ID card before submission.

Phone and fax contacts

Numbers vary by plan, service, and department. Check the member’s ID card before calling or sending a fax.

Phone lines28
  • (800) 243-1809Aetna Virtual Assistant Phone LineAetna line with a virtual assistant that asks callers whether they are an Aetna member or a medical or dental healthcare professional.Answered by: AI assistant
  • (800) 259-2268Aetna Member ServicesAetna member services line whose virtual assistant asks whether the caller is an Aetna member or a medical or dental healthcare professional.Answered by: AI assistant
  • (800) 262-5505Aetna Virtual AssistantAetna virtual assistant line that asks whether the caller is an Aetna member or a medical or dental healthcare professional, with Spanish on press 4.Answered by: AI assistant
  • (800) 282-0555AetnaAetna line with a virtual assistant that offers provider search, ID cards and claims help, and asks whether the caller is a member or a healthcare professional.Answered by: AI assistant
  • (800) 296-9045Aetna Virtual AssistantAetna virtual assistant that offers help finding a provider, ordering an ID card, and understanding claims or plan information. It asks whether the caller is a member or a healthcare professional.Answered by: AI assistant
  • (800) 297-6972Aetna certificate of prior group health plan coverage line: 800-297-6972Recorded Aetna notice about the certificate of prior group health plan coverage that was mailed to members.Answered by: Automated phone menu
  • (800) 333-4432Aetna Phone MenuAetna line whose menu asks whether the caller is an Aetna member, a medical or dental professional, or not yet a member and wants to inquire.Answered by: Automated phone menu
  • (800) 414-0596Aetna Provider Routing MessageRecorded routing message telling providers to hang up and call the member services number on the ID card, or to stay on the line for claim status.Answered by: Recorded message
  • (800) 435-7324Aetna Service Advocates for UPSAetna virtual assistant line for the UPS service advocates that asks whether the caller is a member or healthcare professional and offers help with providers, ID cards, claims and plan information.Answered by: AI assistant
  • (800) 451-7715Aetna National Dentist LineAetna National Dentist Line that asks callers to say or enter an NPI or tax ID and points to aetnadental.com for eligibility.Answered by: Automated phone menu
  • (800) 525-6250Aetna Virtual AssistantAetna virtual assistant line that offers provider search, ID card orders, and claims or plan information, and asks whether the caller is a member or healthcare professional.Answered by: AI assistant
  • (800) 587-0483Aetna Virtual AssistantAetna virtual assistant line that helps with finding a provider, ordering an ID card, and claims or plan questions.Answered by: AI assistant
  • (800) 624-0756Aetna Provider ServicesAetna Provider Services AI line that asks providers for an NPI, tax ID, or provider ID before it helps.Answered by: AI assistant
  • (800) 741-4781Aetna Dental LineAetna Dental Line answered by an AI virtual assistant that offers provider search, ID card orders and claims help, and asks whether the caller is a member or dental professional.Answered by: AI assistant
  • (800) 872-3862Aetna Corporate Headquarters Phone MenuAetna corporate headquarters line. It routes healthcare professionals and members, with a transfer for callers who know the name or number of the person they want.Answered by: Automated phone menu → Hold queue
  • (855) 463-0933Aetna Provider Phone TreeMain line for Aetna, with a provider option that leads to a 24-hour nurse line and a care coordinator hold.Answered by: Automated phone menu
  • (855) 676-5772Aetna Main LineAetna main line that routes healthcare providers, callers with an extension and Spanish speakers, and warns about life-threatening emergencies.Answered by: Automated phone menu
  • (855) 695-3416AetnaAetna line with a virtual assistant that offers provider search, ID cards and claims help, and asks whether the caller is a member or a healthcare professional.Answered by: AI assistant
  • (866) 235-5660Aetna Medicare Prescription Drug PlanAetna Medicare prescription drug plan line that sends address-change callers to a key-press path and offers Spanish by voice.Answered by: Automated phone menu
  • (866) 238-1399Aetna Member and Provider ServicesAetna line for members and providers covering dental, pharmacy, medical benefits, eligibility, pre-certification and other provider questions.Answered by: Automated phone menu → AI assistant
  • (866) 385-8046Aetna main phone lineAetna main line for dental, pharmacy, medical benefits and eligibility, and provider questions, routed by keypad.Answered by: Automated phone menu → Live person
  • (877) 238-6200Aetna Virtual Assistant LineAetna line where a virtual assistant answers and asks whether the caller is an Aetna member or a medical or dental professional.Answered by: AI assistant
  • (877) 277-3368Aetna Virtual Assistant Phone LineAetna virtual assistant that answers first and can help find a provider, order an ID card, and explain claims or plan information.Answered by: AI assistant
  • (877) 368-6605Aetna Virtual AssistantAetna virtual assistant line that asks whether the caller is a member or healthcare professional, with Spanish on 4.Answered by: AI assistant
  • (877) 535-2128Aetna Concierge TeamAetna concierge line for Dick's Sporting Goods that asks callers whether they are a member or a medical or dental healthcare professional.Answered by: AI assistant
  • (888) 532-3862Aetna One advocate teamAdvocate team line for Booz Allen Hamilton where pharmacy inquiries and healthcare professional calls are split by key 1.Answered by: Automated phone menu
  • (888) 632-3862Aetna Provider ServicesAetna Provider Services AI assistant that asks providers for an NPI, or a tax ID or provider ID if the NPI is unavailable, and then asks how it can help.Answered by: AI assistant
  • (888) 802-3862Aetna Virtual AssistantAetna main line with a voice virtual assistant that asks callers whether they are an Aetna member or a medical or dental healthcare professional; Spanish is press 4.Answered by: AI assistant
Phone numbers31
Aetna phone numbers
Channel and numberPayer NotesDepartmentSpecialties
phone(203) 399-5130Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • Other Source of Information
phone(214) 276-6376Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • Other Source of Information
phone(305) 760-8739Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • Other Source of Information
phone(646) 473-7160Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • Other Source of Information
phone(786) 618-1080Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • Other Source of Information
phone(800) 225-7620Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • Other Source of Information
phone(800) 374-1835Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • Other Source of Information
phone(800) 414-0596Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • Other Source of Information
phone(800) 521-3605Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • Other Source of Information
phone(800) 735-7053Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • Other Source of Information
phone(833) 577-2586Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • Other Source of Information
phone(866) 238-1399Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • Other Source of Information
phone(866) 553-8206Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information
  • Other Source of Information
phone(800) 279-1878Other stated contextBenefit context: Active Coverage; Benefit context: Inactive
  • Aetna Better Health of Virginia
Health Benefit Plan Coverage
phone(800) 441-5501Other stated contextBenefit context: Active Coverage
  • Aetna Better Health of Florida
Health Benefit Plan Coverage
phone(800) 624-3879Other stated contextBenefit context: Inactive
  • Mercy Care Arizona
Health Benefit Plan Coverage
phone(844) 362-0934Other stated contextBenefit context: Active Coverage
  • Aetna Better Health of New Jersey
Health Benefit Plan Coverage
phone(844) 365-4385Other stated contextBenefit context: Active Coverage; Benefit context: Inactive
  • Aetna Better Health of Oklahoma
Health Benefit Plan Coverage
phone(844) 528-5815Other stated contextBenefit context: Active Coverage
  • Aetna Better Health of Florida
Health Benefit Plan Coverage
phone(855) 232-3596Other stated contextBenefit context: Active Coverage
  • Aetna Better Health of New Jersey
Health Benefit Plan Coverage
phone(855) 242-0802Other stated contextBenefit context: Active Coverage
  • Aetna Better Health of Louisiana
Health Benefit Plan Coverage
phone(855) 300-5528Other stated contextBenefit context: Active Coverage
  • Aetna Better Health of Kentucky
Health Benefit Plan Coverage
phone(855) 364-0974Other stated contextBenefit context: Active Coverage; Benefit context: Inactive
  • Aetna Better Health of Ohio
Health Benefit Plan Coverage
phone(855) 463-0933Other stated contextBenefit context: Active Coverage
  • Aetna Better Health of Virginia
Health Benefit Plan Coverage
phone(855) 676-5772Other stated contextBenefit context: Active Coverage; Benefit context: Inactive
  • Aetna Better Health of Michigan
Health Benefit Plan Coverage
phone(866) 316-3784Other stated contextBenefit context: Active Coverage; Benefit context: Inactive
  • Aetna Better Health of Michigan
Health Benefit Plan Coverage
phone(866) 329-4701Other stated contextBenefit context: Active Coverage; Benefit context: Inactive
  • Aetna Better Health of Illinois
Health Benefit Plan Coverage
phone(866) 600-2139Other stated contextBenefit context: Active Coverage
  • Aetna Better Health of Illinois
Health Benefit Plan Coverage
phone(866) 638-1232Other stated contextBenefit context: Active Coverage
  • Aetna Better Health of Pennsylvania
Health Benefit Plan Coverage
phone(866) 827-2710Other stated contextBenefit context: Active Coverage
  • Aetna Better Health of Maryland
Health Benefit Plan Coverage
phone(888) 348-2922Other stated contextBenefit context: Inactive
  • Aetna Better Health of West Virginia
Health Benefit Plan Coverage

Numbers stated in payer eligibility responses; scope may depend on benefits, products, or departments.

Retired numbers4

These numbers played a not-in-service recording when called. Do not use them; call the replacement or the number on the member’s ID card.

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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