Aetna timely filing limit, claim disputes and Availity guide
Aetna's provider manual does not print a claim filing deadline; it says the terms of your agreement govern and control. What Aetna does publish is the dispute clock: 180 calendar days from the initial claim decision to ask for a reconsideration, then 60 calendar days to appeal for most non-Medicare providers, with state exceptions on fully insured plans.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: your Aetna filing limit comes from your agreement, since the provider manual states none. Disputes start with a reconsideration within 180 calendar days of the claim decision, and the one-level appeal for non-Medicare providers is due within 60 calendar days of the previous decision. Most of it runs through Availity.
Aetna filing, prior authorization and portal
Appeal levels
Top denials from Aetna
| Code | Meaning | Our fix |
|---|---|---|
| CO-197 | Precertification, authorization or notification absent | Confirm precertification in Availity; if none, file a retroactive-authorization appeal, which Aetna lists as appealable. Do not bill the member. |
| CO-29 | The time limit for filing has expired | Compare the claim to the filing sentence in your contract, then reconsider with proof of the original submission date. |
| CO-16 | Claim lacks information or has submission or billing errors | Read the rejection report, correct the missing element (member ID, NPI, dates, referral) and resubmit through Availity. |
| CO-22 | This care may be covered by another payer per coordination of benefits | Bill the primary first, then send the COB claim electronically with the primary payer's result. |
| CO-50 | Not deemed a medical necessity by the payer | Appeal with medical records and the clinical rationale; Aetna asks for records on medical-necessity reviews. |
What does Aetna publish about filing and disputes?
Aetna publishes the dispute and appeal clock on its provider appeals pages, and the workflow in its provider manual (document 4983700-01-01, May 2025 edition). The manual says that if its policies and your agreement differ, the terms of your agreement govern and control, and that state law can override the manual.
| Question | What Aetna's documents say |
|---|---|
| Claim filing limit | Not stated in the manual. It describes a clean claim as one received in a timely manner; the number comes from your agreement. |
| Reconsideration | Within 180 calendar days of the initial claim decision. Aetna decides within 45 business days. |
| Appeal, non-Medicare providers | Within 60 calendar days of the previous decision. Aetna decides within 60 business days. |
| Appeal, Medicare-contracted providers | Within 60 calendar days of the previous decision; 60 business days to decide. |
| Appeal, Medicare non-contracted providers | Within 65 calendar days of the previous decision; 60 business days to decide. |
| Levels of appeal | One. Practitioners and organizational providers cannot file a second level. |
| Portal | Availity, for eligibility, authorizations, referrals, claims, status and disputes. |
Aetna's overview page says some states have different time frames, which is why the exceptions table below matters.
Which portal or clearinghouse do I use to submit claims and check status with Aetna?
Use Availity for claims, claim status, eligibility, authorizations and disputes, or submit through your clearinghouse in the X12 837 format. The manual says you can submit professional and institutional claims in Availity at no charge, including COB claims and corrected and voided claims.
The manual lists the payer ID "57604" only for Aetna Voluntary Plans. For other plans take the ID from the member ID card or your clearinghouse enrollment, and see the manual's claims address table, which splits states between a Lexington, KY and an El Paso, TX mailing address. Aetna Signature Administrators, Meritain Health and Schaller Anderson (Medicaid) members are directed to the ID card.
For claim status, run the Claim Status Inquiry. It shows payment details and remark codes, lets you download the EOB and upload attachments when a claim is pended or finalized. The manual asks you to use real-time HIPAA transactions for authorization, claim status, eligibility and benefits, and referrals, and to correct and resubmit rejected claims through your vendor after reading its rejection reports.
How do I handle corrected claims and timely filing with Aetna?
Send corrected and voided claims through Availity's claim submission, and treat your agreement as the source for how many days you have. The manual names the channel but does not state a filing number or a frequency code in the pages that cover claims.
A clean claim, in the manual's words, is received in a timely manner and carries all the data elements of the UB-04 or CMS-1500, including member ID, NPI, dates of service and a full breakdown of services, plus any required referral.
Run the dates with our timely filing calculator once you have the number from your contract, and compare payers on the timely filing rule.
What are the Aetna dispute steps in order?
Aetna gives providers one reconsideration and one appeal, and no second appeal. Pick the route by what you disagree with: a reimbursement or coding decision, or a claim that needs reprocessing, goes to reconsideration; a medical-necessity or experimental decision, or a denial for missing authorization, goes to appeal.
- Make sure the claim is Finalized. In Availity open Claim Status, select the claim and choose Dispute Claim.
- Complete the dispute and submit it. A dispute left in Initiated status is not sent to Aetna.
- Attach the appeal form, the denial letter or EOB, the original claim and the records when you appeal, unless you file in Availity.
- Count the due date from the decision you are disputing.
What does the Aetna manual say about hospital and ED claims?
Notify Aetna of every inpatient admission, including those through the emergency department, within two business days. If the patient is unable to give coverage information, contact Aetna as soon as you learn of the coverage and explain the circumstances. No plans require a referral for emergency services, but out-of-network follow-up care after an emergency needs precertification, and suture removal, cast removal, X-rays and ED revisits are listed as follow-up care.
| Topic | What the May 2025 manual says |
|---|---|
| Emergency definition | Acute symptoms severe enough that a person with average health knowledge could expect that no medical attention would result in serious harm; for pregnancy, the health of the woman and the unborn child count. State mandates may apply. |
| DRG interim bill | A hospital can send a claim for part of a stay. Aetna pays the first interim bill from the admitting information and the balance on the final bill. |
| DRG review | Claims billed with a DRG can be reviewed before or after payment by medical record review. You receive a narrative and a proposed DRG revision and can then address disagreements. A DRG short-stay review is a post-payment check of the setting of care on Medicare risk inpatient claims. |
| Prepayment review | Aetna may review records before processing, including itemized bills for percentage-of-charges contracts. Denials can result from duplicate charges, billing errors or categorization of capital equipment. |
| Overpayments | Aetna typically notifies commercial providers within 24 months of the original payment and Medicare providers within 36 months, subject to law. |
| Billing the member | You may not bill or balance bill a member when a claim is denied for an administrative reason such as a missing referral or authorization. For a non-covered service you must tell the member beforehand and get written consent; a general financial responsibility form is not enough. |
What are Aetna's state exceptions to the 180-day dispute standard?
Aetna applies a 180-day dispute filing standard unless an exception applies, and the exceptions cover members on fully insured plans only. Aetna says state law generally does not apply to its Medicare plans and most self-insured plans, so these exceptions do not reach them.
| State | Who it covers | Time to file an initial claim-payment dispute |
|---|---|---|
| Arizona | All providers | 1 year |
| California (HMO) | All providers, date of service on or after 1/1/04 | 365 days |
| California (traditional) | All providers, appeal received on or after 6/29/09 | 180 days |
| Colorado | All providers | 12 months |
| Florida | Licensed physicians, physician assistants, osteopaths, chiropractors, podiatrists, dentists (not facilities) | 12 months |
| Georgia | All providers | 24 months from date of service or discharge |
| Indiana | All providers, claims paid on or after 7/1/06 | 2 years from claim payment date |
| Kentucky | Participating providers only | 2 years |
| Maryland | All providers | 365 days |
| New Jersey | Fully insured members; PICPA arbitration route | 90 calendar days from notice of the determination, and 18 months from first payment for underpayment |
| North Carolina | All providers | 2 years from original claim payment |
| Ohio and Oklahoma | All providers | 2 years |
| Oregon and Washington | All providers | 18 months (Oregon) or 24 months (Washington) from denial or payment date, 30 months if COB issues |
| Rhode Island | All providers | 18 months |
| Tennessee | All providers | 15 months |
| Utah | All providers | 12 months, 24 for COB errors, 36 for government program recovery |
| Texas | Participating providers and nonparticipating paid on a participating basis | 4 years to file and pursue a dispute |
How do I check eligibility and submit prior authorization for Aetna members?
Check eligibility and benefits in Availity first, then use the Precertification Code Search tool and the Online Precertification transaction to see whether a service needs precertification and to request it. The code search accepts up to five CPT codes at a time.
Precertification applies to services on the Aetna Participating Provider Precertification List, the Behavioral Health Precertification List and anything a member's plan requires. You can submit by EDI, through Availity or by phone using the number on the member ID card. A pending reference number is not an approval.
Notify Aetna of all inpatient admissions, including those through the emergency department, within two business days of the admission. The manual also bars you from billing or balance billing the member when a claim is denied for administrative reasons such as a missing referral or authorization. See our prior authorization and eligibility verification work.
What does Aetna say about the No Surprises Act and out-of-network claims?
Aetna's manual puts compliance on you: it is your responsibility to comply with all applicable law, including the federal Health Care Price Transparency Act and the No Surprises Act. Its contracts do not stop participating providers from disclosing rate or payment information when required.
The manual also applies the No Surprises Act continuity-of-care rules to terminated providers. Providers cannot balance bill continuing care patients for more than the in-network cost share, and must keep accepting the rates in effect before termination. For continuity of care, the manual applies federal requirements first with state requirements filling gaps such as balance billing, and the better benefit for the member applies if they conflict. Steps for the federal process are on our open negotiation and state surprise billing laws pages, and our out-of-network billing and IDR service covers the work.
Where should I look next?
Confirm the numbers against your contract and the current manual on Aetna.com. Compare with UnitedHealthcare and Cigna, or read about denial management.
- Aetna Provider Manual (4983700-01-01, 5/25) · Aetna
- Provider appeals: state exceptions to filing standard · Aetna
- Disputes and appeals overview · Aetna
- Health care professionals dispute process FAQs · Aetna
- X12 claim adjustment reason codes · X12
We check every rule, code and deadline against the official source. See our editorial policy.
Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What is the Aetna timely filing limit for claims?
Aetna's provider manual (May 2025 edition) does not state a claim filing number. It says the terms of your agreement govern and control if they differ from the manual. The 180-day figure Aetna publishes is for filing a dispute, not an initial claim, so read the filing sentence in your own contract.
02What are the Aetna appeal levels and deadlines for a denied claim?
Aetna allows one level of appeal for providers. A reconsideration is due within 180 calendar days of the initial claim decision. A non-Medicare appeal is due within 60 calendar days of the previous decision, and Medicare non-contracted appeals within 65. Some states set longer periods for fully insured plans.
03How do I check eligibility and submit prior authorization for Aetna members?
Use Availity. Check eligibility and benefits there, run the Precertification Code Search tool for up to five CPT codes, and send the request through the Online Precertification transaction, EDI or the phone number on the member ID card. Notify Aetna of inpatient admissions within two business days, including admissions through the emergency department.
04What are the most common Aetna denial reasons for hospital and ER claims?
Aetna's manual does not rank denial reasons. This page covers five CARCs that match processes the manual and appeals pages describe: CO-197 for missing authorization, CO-29 for timely filing, CO-16 for missing information, CO-22 for coordination of benefits and CO-50 for medical necessity, with the fix each source supports.
05How do I dispute an out-of-network underpayment from Aetna through open negotiation and IDR?
Start with a reconsideration in Availity within 180 calendar days of the claim decision. The federal open negotiation and IDR steps run on their own deadlines under the No Surprises Act, which Aetna's manual says you must follow. Our No Surprises Act pages set out those dates; Aetna's own appeal clock does not replace them.
06Which portal or clearinghouse do I use to submit claims and check status with Aetna?
Use Availity for claims, claim status and disputes, or your clearinghouse in X12 837 format. Availity accepts professional and institutional claims, COB claims and corrected and voided claims at no charge. The manual publishes payer ID 57604 only for Aetna Voluntary Plans, so take other IDs from the member ID card.
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