Aetna·AL, AZ, AR, CO, DE, FL, GA, IL, IN, IA, KS, LA, ME, MI, MN, MS, MO, NE, NV, NY, NC, OH, PA, SC, TX·Newsletter
Effective date
Jun 1, 2026
We identified it
Mar 31, 2026
Days to comply
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Summary
This is an informational newsletter (OfficeLink Updates - March 2026) containing multiple policy updates and operational guidance for Aetna providers. Key items include: (1) new claim edits effective June 1, 2026 as part of the Claim and Code Review Program (CCRP); (2) an update to the treatment room services policy (originally effective April 1, 2021); and (3) reminders about prior authorization submission procedures, provider profile maintenance, and behavioral health resources. The newsletter applies to Commercial and Medicare lines of business unless otherwise specified.
Action Required
Action needed
By June 1, 2026: Billing team must prepare for new claim edits that will be implemented as part of Aetna's Claim and Code Review Program (CCRP). Review the claim edits available on the Aetna provider portal (Availity) to understand which claims may be affected. Update internal billing procedures and staff training to accommodate new editing logic. Monitor claim rejections and denials after June 1 to identify patterns related to the new edits. Additionally, review the updated Treatment Room Services policy (details in full PDF) to ensure compliance with any coding or billing changes. Prior to the June 1, 2026 effective date, ensure all provider profile information is current in the Availity Provider Data Management (PDM) tool to avoid removal from the provider directory. Reminder: When submitting prior authorizations via Availity, providers should select the correct admission type (Elective, Emergency, or Urgent) and only use Urgent/Emergency status when the standard timeframe would jeopardize patient life or health; use the Provider Notes box to justify urgent/emergency requests.