Forms

ERA and EFT enrollment forms have changed. Enroll by downloading the paper forms or enroll electronically by visiting the our Secure Web Portal.

Make sure your contact information is current with us. All you have to do is log in to our Secure Web Portal and completethe practitioner information change form.

If you have not registered to access to our Secure Web Portal, then fill out the Secure Web Portal registration form. Once your secure web portal registration form has been processed, you will receive your user name and password.

Electronic remittance advice is an electronic file that contains claim payment and remittance information sent to your office. This is sometimes referred to by its HIPAA transaction number, 835.

The benefits of an ERA

  • Reduces manual posting of claims payment information, which saves you time and money, allowing you to more efficiently manage your resources
  • Eliminates the need for paper explanation of benefits (EOBs)

Fill out the ERA/EFT enrollment forms and submit them via our secure fax at 860-262-7836 or via email to Medicaidfinance-PA@aetna.com. Allow 10-15 business days for processing once enrollment form is received. We'll send a confirmation letter to your office indicating the process has been completed.

Need help?
Please contact Provider Relations at 1-866-638-1232 or email ABHProviderRelationsMailbox@AETNA.com with any questions or to check enrollment status. You can also send us a message via our website using the contact us form.

Electronic fund transfer offers electronic payments deposited directly into providers’ bank accounts.

The benefits of an EFT

An EFT can improve the consistency of your payments and provide fast, accurate and secure payments directly into your bank account.

Please allow 10-15 business days for processing once enrollment form is received. We'll send a confirmation letter to your office indicating the process has been completed.

Need help?
Please contact Finance at 1-866-638-1232 or e-mail Medicaidfinance-PA@aetna.com with any questions or to check enrollment status. You can also send us a message via our website using the contact us form.

Pharmacy prior authorization request forms are located here