Aetna - Dental Claim Form & Instructions Accessible PDF - Aetna - Dental Claim Form & Instructions 2026

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4.9 out of 5

37 votes

The document outlines the claim instructions for dental benefits, emphasizing the legal consequences of submitting false or misleading information in insurance claims across various states. It details the necessary steps for both employees and dentists to complete the claim form accurately, including sections for personal information, treatment details, and authorization for information release. Additionally, it highlights the importance of filing for Predetermination of Benefits when applicable and provides contact information for submitting claims.

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Click ‘Get Form’ to open the Aetna - Dental Claim Form in our editor.
Begin by filling out blocks 1–22 with your personal information, including your employer's name, policy number, and your Aetna ID number.
Complete blocks 23–27 only if you have other dental coverage. This ensures all relevant insurance information is captured.
Sign the authorization to release information in block 28. This is crucial for processing your claim.
If you want benefits paid directly to your dentist, sign block 29. Make sure all signatures are clear and legible.
For dentists, check the box for 'STATEMENT OF SERVICES RENDERED' and complete blocks 30-48 with detailed service descriptions and fees.
Once completed, review the form for accuracy before submitting it to Aetna Dental at the provided address.

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Versions	Form popularity	Fillable & printable
2022	4.9 Satisfied (37 Votes)
2019	4.2 Satisfied (51 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is payer ID 60054?

Electronic claims Submit your dental claims and encounters electronically. Payer ID numbers are 60054 for Aetna claims and 68246 for Aetna encounters.

What is the PO box for Aetna claims?

Log in to your member account and go to the Message Center. Sent a request to: Aetna, PO Box 981026, El Paso, TX 79998-1206. Email Aetna Member Services.

What is an Aetna payer ID?

A payer ID serves as a specific identifier that insurance companies use to process electronic claims. To cite an instance, Aetnas payer ID 60054 works with any clearinghouse. National payers like Aetna (60054), Cigna (62308), and United Healthcare (87726) use the same payer IDs with all clearinghouses.

How to submit a corrected claim to Aetna?

You can submit corrected and voided claims electronically. Just include the originally assigned claims number. Include a procedure code description for codes not otherwise classified or listed. Ask your vendor where to include this information.