Helpful Links
Complete Your Required Medicare Compliance Training and Attest by October 31, 2025
We require participating providers in our Medicare Advantage (MA) plans to meet the Centers for Medicare & Medicaid Services (CMS) compliance program requirements for first-tier, downstream, and related entities (FDR) as outlined in the trainings below.
To learn more about our MA plans, including SNP plans, view our Medicare Advantage quick reference guide.
2025 direct provider notification
In 2025, participating providers received a training and attestation notice to the compliance email(s) submitted with their 2024 attestation. If we didn’t have your email address (or the email was undeliverable), a postcard reminder to complete your attestation (and MOC training, if applicable) was mailed during the summer.
How to submit your attestation
If you did not receive a notice or have not completed your required training(s), please visit the Medicare compliance and attestation page to review the materials and submit your attestation.
Training materials
Attestations based on contracted plans
Providers:
Delegates:
Where to get more information
If you have questions, please click on the above links or review the quarterly First Tier, Downstream, and Related Entities (FDR) compliance newsletters.
Claim and Code Review Program (CCRP) Update
Starting December 1, you might see new claim edits. This update applies to both our commercial and Medicare members.
Our program evaluates claims against industry coding guidelines such as those from the Centers for Medicare & Medicaid Services (CMS), American Medical Association Current Procedural Terminology (CPT) coding standards, and evidence-based guidelines from nationally recognized professional health care organizations and public health agencies.
Beginning December 1, 2025, you may see new claim edits. These are part of our CCRP. These edits support our continuing effort to process claims accurately for our commercial, Medicare, and Student Health members. You can view these edits on our provider portal on Availity.
For coding changes, go to Aetna Payer Spaces > Resources. In the search bar, search for “expanded claim edits.”
Except for Student Health, you'll also have access to our code edit lookup tools. To find out if our new claim edits will apply to your claim, log in to Availity. You'll need to know your Aetna provider ID number (PIN) to access our code edit lookup tools.
We may request medical records for certain claims, such as high-dollar claims, implant claims, anesthesia claims, and bundled services claims, to help confirm coding accuracy.
Changes to our National Precertification List (NPL)
These changes apply to our commercial and Medicare members, unless otherwise noted.
Effective January 1, 2026, we’ll require precertification for the following:
Changes to Commercial Drug Lists Begin on January 1
Find out about drug list changes and how to request drug prior authorizations (PAs).
On January 1, 2026, we’ll update our pharmacy drug lists. Changes may affect all drug lists, precertification, step therapy, and quantity limit programs.
You’ll be able to view the changes as early as October 1, 2025. They’ll be on our Formularies and Pharmacy Clinical Policy Bulletins page.
Ways to request a drug PA
Medications on the Aetna Drug Guide, precertification, step-therapy, and quantity limits lists are subject to change.
More information
For more information, refer to the Contact Aetna page and select the Providers tab.
Important Pharmacy Updates
Read the updates for Medicare, Medicare Part B step therapy, and commercial.
Biosimilar additions to Medicare plan formularies
Visit our Medicare drug list page to view the most current Medicare plan formularies (drug lists). We update these formulary documents regularly during the benefits year as we add or update additional coverage each month.
Visit our Medicare Part B Step Therapy page to view the most current Preferred Drug Lists for MA and MAPD members. We update these lists regularly throughout the plan year.
Commercial — notice of changes to PA requirements
Visit our Formularies and Pharmacy Clinical Policy Bulletins page to view:
Student Health
Visit Aetna Student Health to view the most current Aetna Student Health plan formularies (drug lists). Follow these steps:
Aetna federal employee plans
Visit our Aetna Federal Plans website to view the most current formularies (drug lists).
New Provider Onboarding Webinar for Providers and Their Staff
Take our “Doing business with Aetna” webinar to get lots of your questions answered.
New to Aetna? Or do you simply want to see what’s new? Join us in our new provider onboarding webinar - "Doing business with Aetna” - to discover tools, processes, and resources that’ll make your day-to-day tasks with us simple and quick. We’ll show you how to:
Register today
The new provider onboarding webinar - “Doing business with Aetna” - is offered on the second Tuesday and third Wednesday of every month, from 1 PM to 2 PM ET.
Questions?
Just email us with any questions that you may have. We look forward to seeing you in an upcoming session.
Training that Transforms: Meet PatientForward
We’re proud to launch the PatientForward platform - a cutting-edge digital learning environment created to support health care professionals in delivering exceptional patient experiences.
A platform with purpose
PatientForward is more than a training tool - it’s a movement. Built to support practices of all sizes and specialties, this platform offers a structured, engaging, and accessible way to elevate patient care. Whether your team is just beginning its patient experience journey or looking to strengthen its skills, PatientForward meets you where you are, in your own space and at your own pace.
What’s inside?
Through story-driven video lessons that bring patient experience to life, AI-powered simulations and coaching for real-world practice, and live huddle resources to support team collaboration, the platform is delivered in stages, each with bite-sized lessons and powerful tools. Upon the completion of the program, learners receive digital badges via Credly to recognize and celebrate their growth.
Who should participate?
PatientForward offers flexible, role-specific learning that empowers every member of your team to grow, engage, and elevate the care experience. Ideal for: providers (physicians, NPs, PAs), clinical teams (nurses, MAs, techs), and service teams (receptionists, schedulers, managers).
Explore the platform and partner with us
Take the first step toward more meaningful, impactful care by exploring the PatientForward platform today. As part of our ongoing commitment to enhancing the member experience and supporting our provider partners, we’re providing these complementary innovative learning resources to our Medicare provider network - because healthier happens together.
Enhance Patient Care with Biosimilars
Choosing biosimilars helps reduce treatment costs, minimize access barriers, enable the reallocation of savings, and more.
As valued leaders in patient care, you have a powerful impact on our health care industry - not only on individual health outcomes but also on advancing accessible, sustainable health care for all.
Why biosimilars matter
You can make an even greater difference by prescribing biosimilars. These FDA-approved alternatives are clinically equivalent to their reference biologics and offer the same safety and efficacy standards, supported by extensive clinical research and real-world use across diverse patient populations.
Why choose biosimilars
By choosing biosimilars when clinically appropriate, you:
Support and resources
We recognize that biosimilar adoption is also influenced by state-level policy. While we continue to advocate for broader state preferencing of biosimilars, we’re here to support you with the latest:
Find out whether your state supports biosimilar adoption.
2026 Aetna Smart Compare is Coming Soon
Evaluation notifications will begin in late 2025.
The Aetna Smart Compare program
Aetna Smart Compare is a provider designation program that evaluates our participating providers, identifying those that meet higher standards of quality and cost-effectiveness. The national program began in 2021 and has continued to expand by specialty.
Evaluation notification
In late 2025, we’ll notify the physicians we’ve evaluated. These physicians can go to our Aetna Smart Compare Designation page and refer to the Aetna Smart Compare Methodology Guide to access the latest standards and measurements applicable to the evaluation period.
Evaluation period for 2026
The 2026 designations for Aetna Smart Compare evaluate claims data from 2023 and 2024.
How to dispute a designation
Physicians will have an opportunity to dispute the designation before it’s published through a process that includes the following protections:
We’re Launching Informed Choice for Members
Informed Choice will make use of our Aetna Smart Compare program.
We’ll soon launch a new product we’re calling "Informed Choice." This product will make use of our Aetna Smart Compare program, which measures cost and quality across several specialties. Informed Choice, which is designed to enhance current benefits without affecting participation in networks, will be available to the commercial group business in 2026.
Lower copayments for members
Members enrolled in Informed Choice might have lower copayments if they choose physicians designated in Aetna Smart Compare. And if members receive care from orthopedic surgeons designated in Aetna Smart Compare, their inpatient and outpatient surgery copayments for knee, hip, and shoulder replacements could be lower.
Smart Compare designated providers are identified with a “quality & effective care” badge in our provider search.
Physician specialties included
Aetna Smart Compare currently measures physicians under these specialty programs: allergy/immunology, behavioral health — psychiatry, cardiology, cardiothoracic surgery, dermatology, endocrinology, gastroenterology, general surgery, medical oncology, neurology, neurosurgery, nephrology, OB/GYN, orthopedic surgery, otolaryngology, primary care physician (PCP), plastic surgery, pulmonology, rheumatology, urology, and vascular surgery.
Informed Choice creates lower copayments for all of these specialties, except medical oncology.
More information
You can learn more about Aetna Smart Compare by visiting our Smart Compare page.