Availity Provider Portal Login | Aetna (2024)

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Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept".

  • Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider.
  • While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors).
  • Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error.
  • CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. Unlisted, unspecified and nonspecific codes should be avoided.
  • Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern.
  • In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members.

See CMS's Medicare Coverage Center

  • Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change.
  • Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Under certain circ*mstances, your physician may request a peer to peer review if they have a question or wish to discuss a medical necessity precertification determination made by our medical director in accordance with Aetna’s Clinical Policy Bulletin.
  • While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans.

See Aetna's External Review Program

  • The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT®), copyright 2015 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.
  • The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsem*nt by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.


CPT only copyright 2015 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association.

You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.

Go to the American Medical Association Web site

U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsem*nt by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept".

The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services.

This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

Availity Provider Portal Login | Aetna (2024)


What is the Availity portal? ›

The Availity Portal offers healthcare professionals free access to real-time information and instant responses in a consistent format regardless of the payer.

Why can't I log in to Availity? ›

Become locked out of your Availity user account. You have entered your password incorrectly three or more times, or you have entered your backup code or one-time code incorrectly. Have an email address on record, but cannot use your email address to retrieve your user ID or reset your password.

How do I get an Availity account? ›

  1. To begin creating your user account, follow these steps: Go to availity.com and in the upper-right corner of the page, select Get Started next to New to.
  2. Availity? Click Create Account next to the Providers tile.
  3. If you are a caregiver (non-healthcare) or atypical provider, click Create Account next to the Atypical.

Is Aetna the same as Availity? ›

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). Availity® is a registered trademark of Availity, LLC.

What is my Availity customer ID? ›

To determine your customer ID, click Who controls my access? at the top of any page in the Availity Web Portal. Contact Name Name of a contact at the receiving organization (if different than the provider contact).

How do I register a provider in Availity? ›


1. Go to www.availity.com and click REGISTER at the top of the page. 2. Hover the cursor over the Providers tile, and then click REGISTER.

What is Availity in healthcare? ›

Availity is a third party entity that serves as a bridge between healthcare providers and insurance providers. Their goal was to eliminate the gap between insurance companies and providers by providing real time information regarding claim status, eligibility, and payment.

Does Availity have an app? ›

Availity Essentials helps you check eligibility, get authorizations, submit and track claims, and get remits for free in an easy-to-use interface. Upgrade to Essentials Plus and get access to more payers using the Essentials app and workflows with an easy-to-manage subscription.

Who is Availity owned by? ›

Novo Holdings acquired its stake in Availity from Francisco Partners, a global investment firm that specializes in partnering with technology businesses, which had been an investor in the Availity since 2017.

Why is Availity free? ›

Participating health plans fund the cost of Availity's standard transactions that health care providers process through our network. This allows health care providers like you to use core Availity services for free.

Can you get credentialed through Availity? ›

Availity automatically sends your updates to payers who are working with us on their directories. The app shares data with our new credentialing app, which many payers are using to simplify the credentialing and recredentialing process for providers.

Is Aetna part of Availity? ›

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 subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna).

When did Aetna go to Availity? ›

In 2021, Aetna Better Health of California (ABHCA) has partnered with Availity to make it easy for you to work with us online.

How much is Availity? ›

We have one Essentials Plus plan, with early adopter pricing while we continue to build out our payer list. The subscription costs $25 a month and includes unlimited transactions with sponsored payers, plus 250 non-sponsored transactions.

Is Aetna now called CVS? ›

Aetna® is proud to be part of the CVS Health family.

What type of system is Availity? ›

Availity's revenue cycle management solution integrates seamlessly with hundreds of practice management systems, hospital information systems, and electronic medical record systems.

What type of software is Availity? ›

Availity is designed to help businesses in the healthcare industry manage medical benefits, insurance claims, and payment authorizations on a unified platform. The integrated revenue cycle management system enables healthcare professionals to log and track revenue from initial appointments to final payments.

Is Availity a medical billing software? ›

Availity Quick Claims is bridging the gap in digital medical billing for atypical healthcare providers. Availity's innovative digital billing solution makes electronic claims submission a reality for all healthcare services.

What type of company is Availity? ›

Availity has a thriving growth culture. We are a healthcare technology company that operates the most significant real-time information network, working collaboratively with health plans and providers to pursue efficient and straightforward solutions for a sustainable healthcare system.


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