It’s easy to
request
authorization
requests
electronically.
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Precertification. Referral. They’re both authorization requests, but they’re different.
Request precertification for things like inpatient hospital stays and for certain
procedures and services. See the resources on our website. View the lists or
input your procedure code(s) into the tool to see if we require precertification.
Request referral for consultation services and treatment with specialists.
You can submit requests electronically. Just use our provider portal on Availity®.
Or find a vendor from our list — vendor fees may apply. Submitting your requests
electronically saves you time and money. See how much money you can save at
AetnaEDISavingsCalculator.com.
3
Precertification
Learn more about precertification
at AetnaElectronicPrecert.com
Precertification transactions we offer:
• Precertification — Submit a precertification request for services that
require Utilization Management (UM) review.
• Notification of Medical Request — Send us notification of admission or
non-admission services.
• Precertification inquiry — Send an inquiry to look up a previously
submitted request.
Here’s some information, so you can breeze right through precertifications.
What procedures require precertification?
Visit our website to see our precertification list. Or use our precertification
code search tool at the bottom of the page.
This tool:
• Allows you to enter up to five valid CPT or HCPCS codes
• Tells you whether precertification is required, based on the code entered
• Gives you information about the precertification process for services by
external vendors
What information is needed to submit an electronic
precertification request?
Having this information ready will help you complete your request.
Provider identifiers:
The National Provider Identifier (NPI) numbers of the requesting and
servicing providers — get more information on how we use NPIs
on our website
• Contact name and phone number
• Member ID number and date of birth
• Valid diagnosis code (R69 and other non-specific codes will be rejected)
• Place of service
• Admit and/or service date
• Procedure code(s) for non-admissions
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4
Precertification
What else can I do?
• Complete a Precertification Inquiry transaction to get a real-time status of
your request, including expected turnaround time.
When you use Availity, you can do a lot more:
• Add clinical information when it’s in a “Pending” or “Approved” status
• Update your request:
- Change an admitting or attending provider, or the facility or vendor
- Add diagnosis codes (up to five)
- Include a note in the comments field (up to 264 characters)
- Change admission details, such as changing the admit date or adding a
discharge date (cannot be a future date)
- Update, add or cancel procedure codes (up to five)
- Change the service date of a procedure code
- Add additional visits
- Add an end date (optional)
You can cancel your request if the requested service isn’t needed. Just
complete a Precertification Inquiry transaction and click on the “Void” button.
What kind of response can I expect from my request?
• Certified in total: We’ve approved all requested services.
• Modified: We’ve approved your request but modified it. For example, we
may have approved only a portion of the requested length of stay.
• Rejected: We won’t return a certification ID, but we’ll return a tracking
number if you need to contact us. We’ll also tell you why we rejected your
request, including the information submitted in error. Check out our list of
Precertification Status Messages in Appendix 1.
• Pended: We may pend your request if we need more information. Use the
Precertification Inquiry transaction to check its status.*
*If you’re using Availity, you can also get the status of your pended event from
the Availity Auth/Referral dashboard. We send updates every hour.
How may I obtain precertification on certain drugs?
Use Availity to access Novologix®, our portal for Drug Prior Authorization
requests. Novologix is an easy-to-use digital platform, providing real-time,
evidence-based decision support for multi-drug regimens to get patients
started on therapy faster. Novologix streamlines the medical pharmacy prior
authorization process and gives you expedited approvals for requests that
align with National Comprehensive Cancer Network® (NCCN®) guidelines.
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5
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Clinical
questionnaire
The clinical questionnaire is a dynamic tool we developed to help collect clinical
information. It’s located on Availity. When you request precertification on Availity for
certain procedures, we may pend your request for clinical information. At times,
we’ll ask you to complete a clinical questionnaire by clicking the “Take me to clinical
questionnaire” button. Complete the questionnaire, and we’ll give you decision right
away. You may even receive an immediate approval.
Completing the questionnaire online saves you time because we’re asking for the
information upfront. If you receive our immediate approval, you won’t need to fax or
upload clinical information.
6
Referrals
You can request an electronic referral for any plan that requires it. If a plan
requires a referral, it must be issued from the primary care physician (PCP)
for all specialist visits, including those services performed in a facility.
A referral isn’t a substitute for a service that requires precertification.
Visit our website to see if a service requires precertification.
You can find our electronic Referral Add and Inquiry transactions on our
provider portal on Availity. Or find another vendor on our list.
Referral requirements
To request a referral, you must be:
• A participating Aetna® provider designated as a PCP. In some states,
Ob/Gyns may act as the PCP. The PCP making the referral must participate
in the member’s benefits plan.
• A participating Ob/Gyn may create a referral for certain services to specific
specialties (health maintenance organization [HMO] products only).
Search for participating providers in our online referral directory. Referrals
may be issued to an individual specialist using their National Provider
Identifier (NPI) or to a specialty using a taxonomy code. Get more information
on how we use NPIs on our website. Or you can refer to Appendix 2 for a
list of taxonomy codes.
Here are some other things
we’d like you to know:
• Referrals aren’t required for direct-access services,
such as routine eye care and ob/gyn services. Refer to our
Office Manual for Health Care Professionals for a list
of direct-access specialties.
• If you’re part of an independent practice association (IPA),
follow current referral procedures for members HMO plans.
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7
Referrals
Required data
Requesting Provider NPI
Member ID and date of birth
Referred to Provider NPI or
taxonomy code for the specialist
Diagnosis code (optional)
Procedure code (optional)
Referrals for Managed Choice® plan and Elect Choice® plan members are valid
for one year from the original issue date. HMO referrals are valid for 90 days
from the date entered. The first visit must be used within 90 days. After the
initial visit, any remaining authorized visits will expire one year from the original
issue date. The referral is available for use until it expires as described above or
all visits are used — whichever comes first. If you need to change any
information on the existing referral, send a new referral request. You’ll get a new
authorization number and can give that to the member and/or the specialist.
Inquiring about submitted referral requests
You can inquire about a specific referral by using the previous review
authorization number. Or by searching for a member/provider combination.
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• Regardless of the plan type, when you inquire about a previously authorized
referral, we’ll tell you the number of authorized and remaining visits.
• Inquiries for a provider/member combination will return the five most
recent referrals that match the criteria. If there are additional referrals, they
won’t be displayed on a general inquiry.
If you have the certification ID, you should inquire electronically by
performing a search for that specific number. Inquiries for a specific referral
will get information on that referral only.
See Appendix 3 for a list of Referral Status Messages.
Health plan and accountable care organization (ACO) referrals
There are two types of referrals that you may need to make for your patients:
• Health plan referrals, which are the ones required by our health plans.
• ACO referrals, which require that patients get a referral from their primary
care physician (PCP) before seeing a specialist.
If we require a referral to a specialist, it’s important to refer your patients to
specialists and providers within their ACO. Even if we don’t require a formal
referral for your patient to see a specialist, refer your patients to specialists/
providers within their ACO. Talk to your ACO patients about referral options.
This way, they’ll understand the impact of seeing specialists/providers
outside their ACO.
8
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Need help?
If you need help or have questions about precertification or referrals,
send us an email.
Get trained
We offer live webinars on how to do business with us using our provider portal on
Availity. Ask your questions and get answers on the spot. Visit AetnaWebinars.com
for a list of webinars, a schedule and to register.
9
Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Authorization/Access Restrictions
(AAA = 41)
Inquiry transaction:
We are unable to nd the National Provider Identier
(NPI) submitted for the requesting provider in any of the
member’s existing precertication events. Therefore,
the requesting provider does not have privilege to
inquire on the member’s information.
Update Add transaction:
The provider making the EDI update must be aliated
to the original requesting entity that created the event.
Please call the appropriate number below and select
the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for
calls related to indemnity and preferred provider
organization (PPO)-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to health
maintenance organization (HMO)-based benets plans.
Authorization Number Not Found
(AAA = AA)
The Certication Number submitted is not valid or
found in the database.
Verify the Certication Number and submitted member
ID and resubmit the request. If entered correctly, please
call the appropriate number below and select the
option for precertication:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to HMO-
based benets plans.
OR
Enter the request without the Certication Number.
Aetna.com
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Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Cancelled
(HCR01 = C)
Add/Update transaction only.
The event has been successfully cancelled.
For any questions on medical review decisions, please
call the appropriate number below and select the
option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Cancelled
No Prior Approval
(HCR01/03 = C/0N) + message
Inquiry transaction only:
This error will always be accompanied with the
following message:
THE EVENT ASSOCIATED WITH THIS REFERENCE
NUMBER HAS BEEN VOIDED OR IS INCOMPLETE
The event has been successfully cancelled.
For any questions on medical review decisions, please
call the appropriate number below and select the
option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Certication Information Does Not Match Patient
(AAA = CI)
The Certication Number submitted does not
correspond with the member ID submitted with the
request.
Enter the correct Certication Number.
Enter the request without the Certication Number.
Please call the appropriate number below and select
the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
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Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Certied in Total
(HCR01 = A1)
Not applicable No further action required.
Certied-Partial
(HCR01 = A2)
Not applicable Please review decision for each service to determine
what has been certied in total, pended or not certied.
Contact Payer
(HCR01 = CT)
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The procedure code entered may be considered
experimental, cosmetic or investigational.
An EDI update request cannot be completed for a
specic member.
This error will sometimes be accompanied with the
following messages:
THE REQUESTED SERVICE DOES NOT REQUIRE
PRECERTIFICATION BUT MAY NOT BE ELIGIBLE FOR
COVERAGE UNDER THE MEMBERS PLAN PLEASE REFER
TO ONLINE CLINICAL POLICY BULLETINS USING THE
AETNA WEBSITE AND CONTACT PROVIDER SERVICES
OR
AETNA IS TEMPORARILY UNABLE TO PROCESS
UPDATE REQUESTS FOR THIS MEMBER PLEASE
CONTACT AETNA FOR ANY CHANGES TO THIS EVENT
Inquiry transaction:
Internal processing is requesting that the provider
contact Patient Management.
12
Refer to Aetna.com/healthcare-professionals/
policies-guidelines/clinical_policy_bulletins.html
or contact the Provider Contact Center using the
telephone numbers below.
For any questions on medical review decisions, please
call the appropriate number below and select the option
for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Date of Birth follows Date of Service
or Date of Admission
(AAA = 60)
The date of birth is later than the date of service or
admission date.
Verify the date of service and/or the date of admission
and resubmit the request.
Date of Service Not within Allowable Inquiry Period
(AAA = 62)
The admission or date of service is greater than 30 days
from the date of the transaction request.
Resubmit the request when the actual date of the
admission or service is less than 30 days away.
Duplicate Patient ID Number
(AAA = 68)
More than 50 members were identied.
Multiple patients/members found.
Multiple matches on family member.
Please call the appropriate number below and select
the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
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Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Input Error
(AAA = 33)
The data submitted was not valid when processed:
- Length of stay was >99 days.
- Number of units was >999.
- Invalid place of service code, or dierent from
original submission.
- Invalid service/bed type, or dierent bed types using
the same dates.
- Provider role was not valid for the service requested.
- Invalid procedure code was submitted for the
selected place of service.
- Diagnosis code was invalid or missing.
- EDI update transaction not allowed due to the event is
currently being utilized.
- Event no longer able to be updated due to core data
has been modied.
- Discharge Date reported is in the future, or before the
admission date.
- Procedure dates being requested must fall within the
current Admission and Discharge dates.
- The admission date did not equal the same date as
the initial bed day.
- Duplicate Reference Number submitted with initial
request. (UM Delegation only)
- Event has been voided and cannot be updated.
- Duplicate, overlapping, or gaps in Bed Days exist with
update request.
A message segment may also be included with these
errors to report the actual error reason.
Please correct the data and resubmit the request.
If you are unable to determine the reason for the error,
please call the appropriate number below and select
the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
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Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Invalid/Missing Admission Date
Please Correct and Resubmit
(AAA = AM)
Date is not in valid format.
Date is (+ or –) 180 days from transaction date.
Admission date is missing for admission requests.
Please correct the data and resubmit the request.
If you are unable to determine the reason for the error,
please call the appropriate number below and select
the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for
calls related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Invalid/Missing Date-of-Birth
(HCR01 = 58)
Date of Birth is missing or not in the correct format. Correct the date format and resubmit the request.
Invalid/Missing Date(s) of Service
(AAA = 57)
Date is not in valid format.
Date is (+ or –) 180 days from transaction date.
Service start date is missing, or not included in
update requests.
Correct date format and resubmit the request.
If service date is greater than 180 days after transaction
date or greater than 180 days before transaction date,
please call the appropriate number below and select
the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
15
Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Invalid/Missing Diagnosis Code(s)
(AAA = AF)
The diagnosis code submitted was not valid for
submission at the time of the transaction request.
Please correct the data and resubmit the request.
In most instances, the response will display the error code.
If you are unable to determine the reason for the error,
please call the appropriate number below and select
the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Invalid/Missing Discharge Date
(AAA = AN)
Discharge Date is not valid.
Discharge Date reported is in the future.
Please correct the data and resubmit the request.
If you are unable to determine the reason for the error,
please call the appropriate number below and select
the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
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Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Invalid/Missing Patient ID
(AAA = 64)
Invalid patient ID
Ensure you are not entering a letter “O” instead of a
“zero” or a letter “I” instead of a number “1.”
Verify you are entering the correct member ID.
Please call the appropriate number below and select
the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Invalid/Missing Procedure Code
(AAA = AG)
The procedure code submitted was not valid for
submission at the time of the transaction request.
Please correct the data and resubmit the transaction.
In most instances, the response will display the error code.
If you are unable to determine the reason for the error,
please call the appropriate number below and select the
option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
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Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Invalid/Missing Provider Phone Number
(AAA = 46)
Requesting Provider or Information Source contact
telephone number was missing/invalid.
Please correct the data and resubmit the request.
If you are unable to determine the reason for the error,
please call the appropriate number below and select
the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Invalid/Missing Provider Specialty
(AAA = 45)
Used an NPI for that of an individual provider for a
facility role.
NPI reported for the service provider role was not
veried during provider valuation process.
Please correct the data and resubmit the request.
If you are unable to determine the reason for the error,
please call the appropriate number below and select the
option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
18
Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Modied
(HCR01 = A6)
The length of stay that was originally requested
was modied based on Aetna’s internal processing
guidelines.
We changed the requested number of days for an
inpatient admission.
For any questions on medical decision outcomes,
please call the appropriate number below and select
the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
No Action Required
(HCR01 = NA)
The services requested do not require precertication.
The error will be accompanied with the
following message:
NO PRECERT REQUIRED PLEASE REFER TO THE
PROVIDER CODE SEARCH TOOL ON AETNA WEBSITE
THE REQUESTED SERVICE MAY NOT BE ELIGIBLE
FOR COVERAGE REFER TO ONLINE CLINICAL POLICY
BULLETINS USING AETNA WEBSITE OR CONTACT
PROVIDER SERVICES
No action needed, but please review instructions
returned in message.
Aetna.com
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Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
No Certication Information Found
(AAA = NC)
Inquiry transaction only:
No patient event history was located for the member
identied on the request.
Verify the member ID and resubmit the request.
If entered correctly, please call the appropriate number
below and select the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Not Certied
Certication Responsibility of External Review
Organization
(HCR01/03 = A3/0J)
Member ID processed is associated with a delegated
group.
The services being requested for that specic member
have been delegated for utilization management.
Will often be accompanied with the phone number,
or other contact data for the external Utilization
Management Organization responsible for the
member’s care.
Call the delegated group (external review organization)
associated with this member or call the telephone number
returned in the message.
Aetna.com
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Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Not Certied
Duplicate Request
(HCR01/03 = A3/0Q)
A similar current or upcoming event already exists.
During an EDI update the diagnosis, procedure code, or
bed day had already been previously submitted for the
same event.
The following may also be returned in these rejection
responses:
POSSIBLE DUPLICATE REQUEST PLEASE SUBMIT A
PRECERT INQUIRY USING THE PREVIOUS REVIEW
AUTHORIZATION NUMBER RETURNED IN THIS
RESPONSE TO VIEW THE CURRENT STATUS PLEASE
CALL FOR ANY READMISSIONS THAT HAVE OCCURRED
WITHIN 3 DAYS FROM A PREVIOUS INPATIENT STAY
POSSIBLE DUPLICATE REQUEST PLEASE SUBMIT A
PRECERT INQUIRY USING THE PREVIOUS REVIEW
AUTHORIZATION NUMBER RETURNED IN THIS
RESPONSE TO VIEW THE CURRENT STATUS DETAILS
THE SERVICE TYPE REQUESTED TO BE ADDED TO THE
EVENT ALREADY EXISTS TO VIEW THE COMPLETE
DETAILS OF THE EXISTING EVENT PLEASE SUBMIT A
PRECERT INQUIRY
THE DIAGNOSIS CODE OR THE PROCEDURE CODE
REQUESTED TO BE ADDED TO THE EVENT ALREADY
EXISTS TO VIEW THE COMPLETE DETAILS OF THE
EXISTING EVENT PLEASE SUBMIT A PRECERT INQUIRY
Please correct the data and resubmit the request.
If you are unable to determine the reason for the error,
please call the appropriate number below and select the
option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
21
Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Not Certied
Inconsistent with Patient’s Gender
(HCR01/03 = A3/0Z)
Maternity services will only be processed for those
assigned female at birth.
For any questions on medical decision outcomes, please
call the appropriate number below and select the option
for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Not Certied
Level of Care Not Appropriate
(HCR01/03 = A3/0G)
The place of service entered on the request indicated
an ambulatory setting.
The place of service, or bed type, was considered
Medical, but the member has Behavioral Health
benets only.
Neither the Attending provider nor the services
submitted were related to Behavioral Health.
Resubmit the request using an inpatient place of service
value (21, 31, 34, 51, 55 or 56).
Please resubmit using Behavioral Health related data for
the place of service or services.
Please resubmit using a Behavioral Health related
Attending provider or Behavioral Health related services.
Or please call the appropriate number below and select
the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
22
Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Not Certied
No Prior Approval
(HCR01/03 = A3/0N)
Inquiry transaction only:
The services were not certied.
The error will always be accompanied with the
following message:
SEE CORRESPONDENCE FOR DETAILS
For any questions on medical decision outcomes, please
call the appropriate number below and select the option
for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Not Certied
Plan/contractual guidelines not followed
(HCR01/03 = A3/14)
Utilization Management (UM) Delegated arrangement
reported a UM decision for a service outside of the
contract obligations.
Please correct the data and resubmit the request.
Not Certied
Service Inconsistent with Diagnosis
(HCR01/03 = A3/0R)
Maternity events must include both maternity
diagnosis and maternity procedure codes.
The only diagnosis code reported was considered
“unknown”.
The error may be accompanied with the following
message:
PLEASE RESUBMIT YOUR TRANSACTION WITH A
DIAGNOSIS CODE THAT CAN BE USED TO ASSIST
WITH THE UTILIZATION MANAGEMENT REVIEW
PROCESS
Correct data entry, or call the appropriate number below
and select the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
23
Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Not Certied
Services Were Not Considered Due to Other
Errors in the Request
(HCR01/03 = A3/25)
The request has been rejected due to other reasons
within the same response.
Please evaluate the entire response to identify the root
cause for the rejection, correct the errors and resubmit
the request.
If no other rejection reason is visible then please call
the appropriate number below and select the option for
precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Out of Network
(AAA = 35)
Changing a participating Service Provider to a non-
participating Service Provider is not allowed.
Please correct the data and resubmit the request.
If you are unable to determine the reason for the error,
please call the appropriate number below and select the
option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
24
Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Patient Birth Date Does Not Match That for
the Patient in the Database
(AAA = 71)
An invalid birth date was submitted. Verify the date of birth and resubmit the request.
Please call the appropriate number below and select the
option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Patient Not Eligible
(AAA = 95)
Coverage was terminated prior to the event start date.
Event start date is prior to coverage eective date.
No active medical coverage was found.
Please call the appropriate number below and select the
option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Patient Not Found
(AAA = 67)
We could not match any member using the submitted
member ID.
Verify the member ID number and resubmit the request.
Please call the appropriate number below and select the
option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
25
Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Pended
Requires Medical Review
(HCR01 = A4)
All services requiring medical review will be pended.
Pended responses will sometimes be accompanied
with the following messages:
AETNA NEEDS MORE INFO ABOUT THE SERVICES
PROVIDED AND THE PATIENTS CLINICAL STATUS THE
FACILITY UR DEPT SHOULD PROVIDE COMPLETE
INFO ASAP BUT NOT LATER THAN 48 HOURS FROM
THIS SUBMISSION WE WILL MAKE A DETERMINATION
BASED ON THE AVAILABLE CLINICAL INFORMATION
ADDITIONAL INFORMATION IS NEEDED FOR THIS
REQUEST PLEASE USE THE FOLLOWING URL TO
ACCESS THE REQUEST FORMS LIBRARY AND SUBMIT
THE COMPLETED FORM AND DOCUMENTATION TO
AETNA HTTPS://WWW.AETNA.COM/HEALTH-CARE-
PROFESSIONALS/HEALTH-CARE-PROFESSIONAL-
FORMS.HTML
The Aetna Patient Management area will review the
request and contact the requester.
If this is an urgent or emergent situation, enter the record
electronically and please call the appropriate number
below and select the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
26
Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Provider Not Found
(AAA = 43)
Provider Identier submitted was not found during
provider lookup process.
Please correct the data and resubmit the request.
Contact a network representative to have the NPI added
to the Aetna provider database, or use the link below for
sharing the NPI:
https://www.aetna.com/health-care-professionals/
forms/npi-submissions.html
If you are unable to determine the reason for the error,
please call the appropriate number below and select the
option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Required Application Data Missing
(AAA = 15)
The request could not be processed due to missing
required data:
• Diagnosis code
• Procedure code (for non-admissions)
• Admission date
• Procedure date, or units
• Place of service
• Service type (bed type) (for admissions)
• Service Provider role
• Reference Number (for UM Delegation Processing only)
Please correct the data and resubmit the request.
If you are unable to determine the reason for the error,
please call the appropriate number below and select the
option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
27
Appendix 1
Precertification status messages
Status or action message Possible reasons for error Action
Subscriber Found, Patient Not Found
(AAA = 77)
The subscriber was found, but the patient could not
be found during the member search.
Verify the member ID number and resubmit the request.
Please call the appropriate number below and select the
option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Unable to Respond at Current Time
(AAA = 42)
Internal system processing errors. Attempt the transaction later. Contact your vendor or
clearinghouse to ask when the system may be available.
If urgent, please call the appropriate number below and
select the option for precertication:
1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
28
Appendix 2
Taxonomy code list
Specialty family and
Aetna specialties
Taxonomy code
ALLERGY and IMMUNOLOGY
Allergy
Allergy (pediatric)
Immunology
Immunology (pediatric)
207K00000X
ANESTHESIOLOGY
Anesthesia (pain management)
207L00000X
CARDIOLOGY
Cardiac electrophysiology
Cardiology
Cardiology (invasive)
Cardiology (pediatric)
207RC0000X
Specialty family and
Aetna specialties
Taxonomy code
CARDIOVASCULAR and
CARDIOTHORACIC
Cardiothoracic surgery
Cardiovascular surgery
Peripheral vascular disease
Thoracic surgery
Vascular surgery
2086S0129X
CHIROPRACTIC
Chiropractic
Manipulative therapy
111N00000X
DERMATOLOGY
Dermatology
Dermatology (pediatric)
Dermatopathology
207N00000X
Aetna.com
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Appendix 2
Taxonomy code list
Specialty family and
Aetna specialties
Taxonomy code
ENDOCRINOLOGY
Diabetology (pediatric)
Endocrinology
Endocrinology (pediatric)
Metabolism and diabetes
Nutritional medicine
Nutritional medicine (bariatrician)
Nutritionist
Registered dietitian
Reproductive endocrinology
207RE0101X
GASTROENTEROLOGY
Colon and rectal surgery
Gastroenterology
Gastroenterology (pediatric)
Hepatology
Proctology
207RG0100X
Specialty family and
Aetna specialties
Taxonomy code
GENERAL PRACTICE
Adolescent medicine
Developmental medicine
Family practice
General medicine
Gerontology
Internal medicine
Nurse practitioner (adult)
Nurse practitioner (family practice)
Nurse practitioner (geriatric)
Nurse practitioner (pediatric)
Pediatrics
208D00000X
GENETICS
Medical genetics
207SG0201X
Aetna.com
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Appendix 2
Taxonomy code list
Specialty family and
Aetna specialties
Taxonomy code
HEMATOLOGY and ONCOLOGY
Gynecologic oncology
Hematology
Hematology (pediatric)
Oncology
Oncology (pediatric)
207RH0003X
INFECTIOUS DISEASE
AIDS
AIDS (pediatric)
Epidemiology
Infectious disease
Infectious disease (pediatric)
207RI0200X
INFUSION THERAPY
Infusion therapy
261QI0500X
Specialty family and
Aetna specialties
Taxonomy code
NEONATOLOGY
Neonatology
2080N0001X
NEPHROLOGY
Hemodialysis
Hypertensive disease
Nephrology
Nephrology (pediatric)
207RN0300X
NEUROLOGY
Neurology
Neurology (pediatric)
Neuro-ophthalmology
Neurophysiology
2084N0400X
Aetna.com
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Appendix 2
Taxonomy code list
Specialty family and
Aetna specialties
Taxonomy code
NEUROLOGICAL SURGERY
Neurosurgery
Neurosurgery (pediatric)
Neurosurgery (spine)
207T00000X
NUCLEAR RADIOLOGY
Nuclear medicine
Nuclear medicine (pediatric)
2085N0904X
Specialty family and
Aetna specialties
Taxonomy code
OBSTETRICS and GYNECOLOGY
Adolescent gynecology
Gynecology
Gynecologic oncology
Infertility
Nurse midwifery
Ob/Gyn
Obstetrics
Perinatology
Reproductive endocrinology
Urogynecology
Voluntary interruption of pregnancy
207V00000X
Aetna.com
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Appendix 2
Taxonomy code list
Specialty family and
Aetna specialties
Taxonomy code
OPHTHALMOLOGY
Anterior segment (glaucoma)
Corneal specialist
Ophthalmology
Ophthalmology (pediatric)
Optometrist
207W00000X
ORAL and MAXILLOFACIAL SURGERY
Oral medicine
Oral surgery
Oral surgery (pediatric)
1223S0112X
Specialty family and
Aetna specialties
Taxonomy code
ORTHOPEDICS
Hand surgery
Orthopedics
Orthopedics (foot and ankle)
Orthopedics (joint replacement)
Orthopedics (oncology)
Orthopedics (pediatric)
Orthopedics (spine)
Sports medicine
Sports medicine (non-orthopedic)
Surgery
207X00000X
Aetna.com
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Appendix 2
Taxonomy code list
Specialty family and
Aetna specialties
Taxonomy code
OTOLARYNGOLOGY
Audiology
Neuro-otology
Otolaryngology
Otolaryngology (allergy)
Otolaryngology (head and neck)
Otolaryngology (pediatric)
Speech therapy
207Y00000X
PATHOLOGY
Lab work
Pathology
Pathology (pediatric)
207ZP0105X
PEDIATRICS
Adolescent medicine
Nurse practitioner (pediatric)
Pediatrics
208000000X
Specialty family and
Aetna specialties
Taxonomy code
PHYSICAL MEDICINE and
REHABILITATION
Hand rehabilitation
Occupational medicine
Occupational therapy
Physical medicine
Physical medicine and rehab
(pediatric)
Physical therapy
Rehab medicine
208100000X
PHYSICAL THERAPY
Acupuncture
Manipulative medicine
Manipulative therapy
Massage therapy
Occupational therapy
Physical therapy
225100000X
Aetna.com
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Appendix 2
Taxonomy code list
Specialty family and
Aetna specialties
Taxonomy code
PLASTIC SURGERY
Craniofacial surgery
Craniofacial surgery (pediatric)
Oculoplastic surgery
Plastic surgery
Plastic surgery (pediatric)
208200000X
PODIATRIST
Podiatry
213E00000X
PULMONARY DISEASE
Hyperbaric medicine
Pulmonary disease
Pulmonary disease (pediatric)
Respiratory therapy
207RP1001X
Specialty family and
Aetna specialties
Taxonomy code
RADIOLOGY
Magnetic resonance imaging
Nuclear medicine
Neuroradiology
Radiation oncology
Radiation oncology (pediatric)
Radiation therapy
Radiology
Radiology (pediatric)
261QR0200X
RHEUMATOLOGY
Rheumatology
Rheumatology (pediatric)
207RR0500X
SLEEP DISORDER
Sleep disorder diagnostic
261QS1200X
Aetna.com
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Appendix 2
Taxonomy code list
Specialty family and
Aetna specialties
Taxonomy code
SURGERY
Breast surgery
Colon and rectal surgery
General surgery
Oncologic surgery
Pediatric surgery
Proctology surgery
Transplant surgery
Thoracic surgery
Vascular surgery
208600000X
URGENT CARE
Urgent care
261QU0200X
Specialty family and
Aetna specialties
Taxonomy code
UROLOGY
Lithotripsy
Urology
Urology (male infertility)
Urology (pediatric)
208800000X
Aetna.com
36
Appendix 3
Referral status messages
Real-time referral status messages
Below is a list of potential status messages that may appear when a Real-Time Referral Add or Inquiry is successful.
Error message Possible reasons for error Resolution / Action
Authorization/Access Restrictions
(AAA = 41)
Referring provider’s group ID is not designated as
primary.
Referring provider not authorized to submit referrals
(not a PCP or Gyn).
Referring Gyn provider not authorized to refer for this
procedure.
Service (“Referred To”) provider/specialty is not
authorized for Gyn referral.
Service (“Referred To”) provider is not a designated
Aexcel provider for the specialty requested.
Requesting Provider is not associated to any of the
member’s event history.
Resubmit with corrected information.
Check list of allowed procedures for Gyn referrals.
Resubmit using a “Referred To” provider who is
designated for Aexcel®.
Please call the appropriate number below:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Authorization Number Not Found
(AAA = AA)
Inquiry transaction only.
Invalid certication ID (referral number).
Inquired-upon referral number is invalid.
Correct certication ID (referral number) and resubmit.
Submit a general inquiry.
Certication Information Does Not Match Patient
(AAA = CI)
Inquiry only: the referral number submitted is not valid
for the member included in the request.
Correct certication ID (referral number) and resubmit or
submit a general inquiry.
Aetna.com
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Appendix 3
Referral status messages
Error message Possible reasons for error Resolution / Action
Certied in Total
(HCR01 = A1)
Transaction accepted.
Contact Payer
(HCR01 = CT)
The member has behavioral health benets only.
Will always be accompanied with this message:
BEHAVIORAL HEALTH BENEFITS ONLY CONTACT
800 424 4047
Please call the appropriate number as directed in the
message.
Duplicate Patient ID Number
(AAA = 68)
Multiple members found, and unique selection search
could not be made.
Please call the appropriate number below:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Input Error
(AAA = 33)
Invalid Place of Service code. Invalid Taxonomy code. Correct diagnosis and resubmit. Please use ICD10 code.
Invalid Diagnosis Code
(AAA = AF)
Invalid diagnosis code. Correct diagnosis and resubmit.
Invalid/Missing Date of Birth
(AAA = 58)
Date is not in valid format OR date is invalid. Date of
birth is missing.
Correct date or date format.
Aetna.com
38
Appendix 3
Referral status messages
Error message Possible reasons for error Resolution / Action
Invalid/Missing Patient ID
(AAA = 64)
Invalid patient ID.
Conrm zero vs. alpha O, 1 vs. alpha I.
Conrm patient ID and resubmit.
Invalid/Missing Provider Identication
(AAA = 43)
The referring or service provider ID (NPI) submitted was
missing, non-numeric or could not be located during
the provider search process.
Verify provider identier.
If unable to resolve, please call the appropriate
number below:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Invalid Procedure Code
(AAA = AG)
Invalid procedure code. Correct and resubmit.
Use CPT or HCPCS codes.
Modied
(HCR01 = A6)
Service provider changed to a provider that is included
within the capitated arrangement.
Redirect patient to capitated site.
No Action Required
Certication Not Required for This Service
(HCR01/03 = NA/0H)
Referral not required for this member’s product/plan.
Will be accompanied with the message:
MEMBER’S PLAN DOES NOT REQUIRE REFERRAL
Please call the appropriate number below if plan
discrepancy is identied:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
39
Appendix 3
Referral status messages
Error message Possible reasons for error Resolution / Action
No Certication Information Found
(AAA = NC)
Inquiry only.
The Certication ID submitted with the transaction
could not be found.
Will sometimes have a message segment:
MEMBERS PLAN DOES NOT REQUIRE REFERRAL
Correct Certication ID (referral number) and resubmit.
Submit a general inquiry.
Not Certied
Authorization/Access Restrictions
(HCR01/03 = A3/0C)
The procedures requested cannot be certied for the
specialty provider identied in the same request.
Will be accompanied with this message:
PROCEDURES MUST HAVE SAME SPECIALTY
Please call the appropriate number below if plan
discrepancy is identied:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Not Certied
Certication Responsibility of External Review
Organization
(HCR01/03 = A3/0J)
Member is managed by a dierent entity responsible
for Utilization Review.
Will be accompanied with this message of whom to
contact for processing.
Contact the entity that was displayed in the message
segment. Or call the appropriate number below:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
40
Appendix 3
Referral status messages
Error message Possible reasons for error Resolution / Action
Not Certied
Requires Medical Review
(HCR01/03 = A3/0V)
The services requested must be initiated using
the precertication transaction and not the referral
transaction.
Will be accompanied with the message:
PRECERT REGISTRATION REQUIRED. INITIATE
PRECERT ADD REQUEST OR CONTACT PATIENT
MANAGEMENT
Initiate a precertication transaction, or please call the
appropriate number below and select the option for
precertication:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Out of Network
(AAA = 35)
Service provider is nonparticipating.
Referring provider is nonparticipating.
Resubmit with corrected information.
Please call the appropriate number below:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Patient Not Eligible
(AAA = 95)
Member coverage terminated or not yet active. Verify member ID is correct.
Please call the appropriate number below to
verify coverage:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
41
Appendix 3
Referral status messages
Error message Possible reasons for error Resolution / Action
Patient Not Found
(AAA = 67)
No member found for member number submitted. Verify member ID, correct and resubmit.
If member ID is correct, please call the appropriate
number below:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Provider Is Not a Primary Care Physician
(AAA = 49)
The referring provider ID submitted is not a primary
care physician.
Verify provider identier.
Please call the appropriate number below:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Required Application Data Missing
(AAA = 15)
Service (“Referred To”) provider NPI or a specialty’s
taxonomy missing.
Review and complete entry of required information.
Providers must supply Aetna with their NPI before using
their NPI in Aetna’s electronic transactions. Providers
may supply their NPI to Aetna using the “Update
Proles” section of the Aetna provider website.
Aetna.com
42
Appendix 3
Referral status messages
Error message Possible reasons for error Resolution / Action
Subscriber Found, Patient Not Found
(AAA = 77)
The subscriber ID was found, but no dependent
matched the submitted patient date of birth.
Patient could be subscriber, not dependent.
Verify member ID #.
Conrm relationship to subscriber and patient date
of birth.
Correct and resubmit.
If member ID, relationship and date of birth are correct,
please call the appropriate number below:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Unable to Respond at This Time
(AAA = 42)
System unavailable — scheduled maintenance being
performed.
Unplanned communication outage.
Internal system processing errors.
Attempt transaction at another time.
For outages greater than 30 minutes, contact the Vendor
Help Desk for estimated time of availability.
When resubmission not allowed, please call the
appropriate number below:
1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls
related to indemnity and PPO-based benets plans.
1-800-624-0756 (TTY: 711) for calls related to
HMO-based benets plans.
Aetna.com
43
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Availity® is a registered trademark of Availity, LLC.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of
companies, including Aetna Life Insurance Company and its affiliates (Aetna).
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