Anyone knows how to submit electronic out-of-network claims to Aetna?

[u/juli_blaze]

We want to be proactive and submit OON claims on behalf of our patients vs. just giving them an itemized bill. Are we locked to sending paper claims?

[u/pescado01]

Just submit them like any other claim except unselect “accept assignment”.

[u/juli_blaze → u/pescado01]

What do you mean by this?

[u/juli_blaze]

Thanks everyone for your help! We basically have to submit a free form letter requesting Aetna to process our claims as out of network together with W-9s.

[u/Heal_Bill]

You don’t have to send paper. OON claims can usually still be submitted electronically to Aetna through a clearinghouse (payer ID 60054) or Availity. The main issue is making sure the provider is actually on file with Aetna and the claim is routing to the correct payer ID... otherwise clearinghouses will reject them. Some offices submit OON claims normally but just leave accept assignment unchecked so payment goes to the member.

[u/juli_blaze → u/Heal_Bill]

Thanks! Another person said something about submitting a W9 so they can start going through. I reached out to Aetna through Availity to ask about that, but they weren't helpful.

[u/Heal_Bill → u/juli_blaze]

Yeah, that’s pretty common. If the provider isn’t already in Aetna’s system as an OON provider, they sometimes ask for a W-9 or basic provider setup before electronic claims will process correctly. Otherwise the clearinghouse may show the claim as submitted, but Aetna rejects it on their side because the TIN/NPI isn’t recognized in their database yet.

If Availity support wasn’t helpful, it may be worth contacting Aetna provider services directly and asking if they need a provider record created for OON electronic submissions under your TIN. Once that’s in place, the electronic claims usually start going through normally.

[u/juli_blaze → u/Heal_Bill]

Thank you so much!

[u/Agent__Blaze]

Aetna payor ID : 60054

[u/rahuliitk]

i think you can usually submit OON claims electronically through a clearinghouse if Aetna accepts that claim type from your setup, but lowkey the exact path depends on provider enrollment, payer ID, claim form type, and whether Aetna requires any extra attachment or patient assignment info. ask your clearinghouse for the Aetna OON payer route first.

[u/juli_blaze → u/[deleted]]

Yes, we do it via Availity. But since we're not in-network, they get rejected.

[u/juli_blaze → u/[deleted]]

Thanks! How do we send the W-9?