Aetna Health Prior Authorization

Aetna Health prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• Aetna directs providers to use the Availity provider portal for authorizations and related workflows, and for specialty drugs uses Novologix through Availity. Aetna also provides a clinical questionnaire workflow for submitting requested clinical information on Availity or Epic Payer Platform. Specific prior-authorization requirements vary by service, product, and plan, so the safest source of truth is the plan-specific authorization checker and the applicable provider manual.
• Requirements differ by service, plan, and state.
• Some prior authorization requests are handled through Novologix, while others are handled through Availity or Epic Payer Platform.
• This research did not identify one universal authorization form or phone/fax submission path for all Aetna products.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2
• Verification resource 3
• Verification resource 4

How to submit prior authorization requests

• Availity provider portal

• Epic Payer Platform

• Novologix through Availity for specialty drug prior authorization requests

• Submission resource 1

• Submission resource 2

Information commonly required

• Service/procedure details
• Member and provider identifiers
• Clinical supporting information
• Any requested medical records or questionnaire responses

Turnaround notes and caveats

• No single universal turnaround time was located in the official sources reviewed; turnaround is likely request- and plan-specific.
• Aetna states the portal can be used to upload supporting documentation and check status, which implies status tracking is available through the portal.
• Requirements differ by service, plan, and state.
• Some prior authorization requests are handled through Novologix, while others are handled through Availity or Epic Payer Platform.
• This research did not identify one universal authorization form or phone/fax submission path for all Aetna products.

Provider resources

• Provider manuals (official)
• Welcome to Availity (official)
• Electronic transaction tools for providers (official)
• Disputes and appeals overview (official)
• Provider appeals (official)
• Clinical questionnaire for prior authorizations (official)
• Provider manual / office manual PDF (official)

Sources