Find a form
These forms only apply to providers who meet all the criteria below.
Provider is:
- Directly contracted with aetna
- Credentialed in servicing state for add/change request
If you are unsure if the provider is currently credentialed in the servicing state, click here, or call our Customer Service at 800-451-7715.
If provider is not in aetna's directory, click here not the forms below.
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Claims
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Commercial Non-Delegated Dental Offshore Services Attestation
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Disputes and Appeals
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DMO® Forms
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ERA/EFT
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National Provider Identifier
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Office Information Update Forms
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Salzmann Evaluation
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State Specific Forms
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W-9
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies (Aetna). Dental benefits and dental insurance plans are underwritten by Aetna Dental Inc., Aetna Dental of California Inc., and Aetna Health Inc. and/or Aetna Life Insurance Company (Aetna). In Texas by Aetna Dental Inc. and in Virginia, the DMO plan is known as the Dental Network Only plan (DNO). DNO in Virginia is not an HMO. To receive maximum benefits, members must choose a participating primary care dentist to coordinate their care with network providers. Dental PPO insurance plans are underwritten and/or administered by Aetna Life Insurance Company. In Texas, the Dental PPO is known as Participating Dental Network (PDN). Each insurer has sole responsibility for its own products.
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Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
You are now leaving the Aetna Dental Web site and linking to ClaimConnect*.
Aetna Dental works with ClaimConnectTM offered by EDI Health Group (EHG) to provide easy access to check patient eligibility, file a claim, check claim status, view patient rosters and Electronic Remittance Advice.
Links to ClaimConnect and its content are provided for your convenience. Aetna Inc. and its subsidiary companies assume no responsibility for any circumstances arising out of the use, misuse, interpretation or application of any information or other material provided by EDI Health Group (EHG). Aetna Inc. and its subsidiary companies do not endorse any of the products or services available through EHG. EHG independently develops and maintains its own privacy policies and practices.
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