Aetna: Timely Filing, Appeals, and Billing Guide
Aetna is a national commercial and Medicare Advantage payer owned by CVS Health, covering commercial employer plans, individual ACA plans, Medicare Advantage, and Medicaid managed care. Its in-network commercial timely-filing limit is commonly 90 days from the date of service, while appeals typically allow 180 days — confirm both in your contract, since state law can extend the filing window.
- Type
- Commercial, Medicare Advantage, Medicaid
- Timely filing
- 90 days in-network (confirm in contract)
- Appeal deadline
- 180 days commercial; 60 days MA
- Portal
- Availity
What is Aetna?
Aetna is a national health payer owned by CVS Health since 2018. For billers it spans commercial employer and ACA marketplace plans, Aetna Medicare Advantage, Aetna Better Health (Medicaid managed care, contracted by state), and a large self-funded/ASO book where an employer holds the risk and Aetna only administers claims.
Because CVS owns Aetna, some pharmacy and clinical programs route through CVS Caremark and MinuteClinic, which occasionally shows up in coordination and coverage decisions.
What are Aetna\'s timely filing and appeal deadlines?
The number that trips people up is the 90-day in-network commercial filing limit — much shorter than the 12 months providers assume. Out-of-network claims generally get 12 months.
| Line | Typical filing | Typical appeal window |
|---|---|---|
| Commercial in-network | 90 days (per contract) | 180 days (Level 1) |
| Commercial out-of-network | 12 months | 180 days |
| Medicare Advantage | 12-month CMS floor | 60 days (CMS) |
How do you submit to Aetna?
Aetna runs on Availity for eligibility, claim status, and disputes. Send electronic claims through your clearinghouse to payer ID 60054 for most commercial plans (verify on the card). File reconsiderations and appeals through Availity's Dispute tool, which timestamps the submission — critical proof if Aetna later says an appeal was late.
Confirm prior authorization on Availity before service; Aetna's precertification list is extensive for imaging, DME, and specialty drugs.
What billing quirks should you watch?
- 90-day filing. The tight in-network window is Aetna's signature denial driver — build submission SLAs around it.
- State overrides. California, New York, and Texas statutes can extend filing beyond 90 days; cite the statute if Aetna denies a claim filed within the state limit.
- Self-funded plans. Many Aetna cards are ASO; the employer plan document controls coverage, not Aetna medical policy.
- Level 2 is shorter. Do not assume the Level 2 appeal window matches Level 1 — it is often half as long.
Compare against UnitedHealthcare and Cigna when prioritizing your denial work.
Frequently asked questions
For in-network commercial providers Aetna commonly requires claims within 90 days of the date of service, which is tighter than many payers. Non-participating providers generally get 12 months, Medicare Advantage follows the CMS 12-month floor, and Medicaid managed care is often 180 days. State insurance law can override the 90-day rule, so confirm the number in your contract.
Aetna typically allows 180 days from the denial for a commercial Level 1 appeal, with a shorter window (often 60 days) for a Level 2 appeal and for Medicare Advantage. That 180-day window is generous compared with UnitedHealthcare's 65 days, but do not let it lull you — verify the deadline on the specific remittance and in your agreement.
Aetna uses Availity as its primary provider portal for eligibility, claim status, disputes, and appeals. Electronic claims route through your clearinghouse to Aetna payer ID 60054 for most commercial plans. Practitioner and provider complaint/appeal forms and mailing addresses are published on Availity and the Aetna provider site; the correct appeal address depends on the plan and region.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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