Aetna Health Prior Authorization

Aetna Health publishes service-specific prior authorization guidance. Start with the payer resource below, then confirm the member's plan and the requested service before care is scheduled or submitted.

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