Aetna BH Denial Recovery — 2026 Playbook

Aetna commercial + Medicare Advantage BH claims have some of the tightest edit-rules in the market. Post-CVS Health integration + Aetna Signature Administrators + Meritain admin all use different claim submission rules for BH.

Common Aetna BH Denials 2026

1. 90837 downcode to 90834 (MHPAEA parity appealable — see our 90837 recovery guide)
2. PA missing on continued care after initial 6 sessions
3. Modifier 95 telehealth denied post-PHE alignment
4. SUD residential day 5+ denials citing lower level of care

Aetna Appeal Framework

Aetna’s formal appeal process: Level 1 (30 days) → Level 2 (60 days) → external IRE. Parallel: MHPAEA parity complaint to state DOI + Federal DOL if self-funded ERISA plan.

MHPAEA Parity Appeals · Free audit

– KD, Revenant Care