> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Aetna (CVS Health)

> Aetna profile: CVS Health structure, Availity-based transactions, separate dental network, and Evernorth-style carve-out considerations.

**Aetna** is the health insurance arm of **CVS Health**, which also operates Caremark (pharmacy benefit management) and MinuteClinic. For a practice, the operationally relevant facts are the substantial self-funded book, the separate dental network, and heavy use of Availity for provider transactions.

**Payer content ages fastest of anything on this site.** Portals move, forms change, payer IDs get reassigned, and **timely filing limits are contract-specific regardless of what any table says**. Treat this page as orientation; the payer's own current documentation and **your executed contract** are authoritative. **Checked August 2026.**

## Who they are

|                       |                                                                                       |
| --------------------- | ------------------------------------------------------------------------------------- |
| **Parent**            | CVS Health                                                                            |
| **Related entities**  | Caremark (PBM), MinuteClinic, Aetna Better Health (Medicaid)                          |
| **Lines of business** | Commercial (fully-insured and ASO), Medicare Advantage, Medicaid, Individual/Exchange |

## Plan types on the card

Aetna Choice POS II, Managed Choice, Open Access plans, HMO products, Medicare Advantage, and Aetna Better Health Medicaid plans. A substantial share is **self-funded ASO**.

## Enrollment and credentialing

Start at **[aetna.com/health-care-professionals](https://www.aetna.com/health-care-professionals.html)**. Many provider transactions run through **Availity**. Credentialing generally pulls from CAQH.

## EDI, ERA, and EFT

Standard three-part enrollment. Confirm ERA routing to your current clearinghouse and EFT to the **PC's** operating account.

## Appeals

Reconsideration then formal appeal, with the track depending on plan type and line of business.

## Quirks worth knowing

* **Aetna Dental is a separate network** with separate credentialing. Medical participation does not include dental.
* **Behavioral health** may be carved out depending on the plan — confirm per contract.
* **Self-funded volume is substantial**, so ERISA analysis applies to a large share of appeals.


## Related topics

- [The US payer landscape](/concepts/payments/the-payer-landscape.md)
- [Payers vs insurance companies (they're not synonyms)](/concepts/payments/payers-vs-insurance-companies.md)
- [Enroll and contract with commercial payers](/guides/enrollment/enroll-with-commercial-payers.md)
- [Set up EDI, ERA, and EFT with each payer](/guides/enrollment/set-up-edi-era-eft.md)
- [File appeals](/guides/billing/file-appeals.md)
- [How to use the payer reference](/reference/payers/overview.md)
- [Payer enrollment & submission links](/reference/payers/enrollment-links.md)
- [Timely filing limits by payer](/reference/payers/timely-filing-limits.md)