Aetna – Third Party Claim and Code Review Program

Aetna Notice: Beginning December 1, 2021, you may see new claim edits. These are part of our Third Party Claim and Code Review Program. These edits support our continuing effort to process claims accurately for our commercial and Medicare members. You can view these edits on Availity.

We may request medical records for certain claims, such as high-dollar claims, implant claims and bundled-services claims, to help confirm coding accuracy.

Source: https://www.aetna.com/health-care-professionals/newsletters-news/office-link-updates-september-2021/90-day-notices-september-2021/third-party-claim-and-code-review-program.html