Check Claim Status

Quickly look up the status of your claims

It’s easy to check the status of a claim, whether it was submitted on paper or electronically.

Where can I go to check the status of a claim?

You can check claim status:

• By using Aetna Voice Advantage^® (AVA), our interactive telephone self-service system
• By registering or logging in to your secure site
• Through an electronic transactions vendor

See claim instructions for AVA
Log in or register
See a list of electronic transaction vendors

What information do I need to submit a claim status inquiry?

The information you’ll need depends on the method you use to submit an inquiry.

On AVA, you’ll need:

• Provider billing tax identification number (TIN) or NPI
• Patient ID or subscriber’s Social Security number
• Patient date of birth
• Date of service range
• Provider fax number (if a fax back is needed)

For inquiries submitted online, please provide:

• Provider billing tax identification number (TIN) and NPI
• Patient ID or subscriber’s Social Security number
• Subscriber first and last name
• Patient first and last name
• Patient relationship to subscriber
• Patient date of birth
• Patient gender
• Date of service range

What information will I get?

Claim level:

• Claim number
• Total charged amount
• Statement from and through date
• Status message
• Amount paid to the provider
• Claim adjudication date
• Check number/EFT trace number

Line level:

• Procedure code
• Charged amount
• Amount paid to the provider at the line level
• Status codes at the line level
• Line date(s) of service

Why would I get multiple status responses for one claim?

Some possible reasons:

• The claim was split into multiple pieces for claim processing (for example, it spanned two benefit years).
• The claim was reprocessed due to an initial processing error.

Do all rejected claims display as rejected?

You will not see the status of rejected claims if the provider can’t be identified on the rejected claim. The status will also not show as rejected if the system can’t match the information provided.

What if I see a "member not found" response?

This means the member can’t be found in our eligibility file. Try one of the following:

• Review the information for errors. If necessary, send a new inquiry.
• The member information you have may differ from what is in our eligibility file. Use the Aetna eligibility transaction to get member information, and submit a new inquiry using that information.

Submit an eligibility inquiry

When should I report a problem to the vendor?

Report any of these messages to the vendor:

• Response not possible.
• Business application currently not available.
• Payer not responding. Please try again later.

Are there other ways to check on a claim?

You also can check the batch claim status reports from your vendors. Those should show if a claim was rejected or accepted.