Aetna Referral Add Issue

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Please see the following notice sent from Aetna regarding adding referrals electronically. This was posted on Friday and I haven’t seen an update that it’s been fixed.

Purpose:
We’d like to let you know about issues with our Referral Add transaction. The issue is limited to members with ID numbers beginning with “1010” or “1011.”

Overview:

We’re experiencing issues when Referral Add transactions are attempted for members with ID numbers beginning with “1010” or “1011.” We’re returning the error messages of “Unable to Respond” (AAA-42). In some instances, we’re incorrectly returning responses of “Out of Network” (AAA-35) or “Provider is Not a Primary Care Physician” (AAA-49).

We’ll send an updated communication once we’ve scheduled a fix for this issue.

As there’s no workaround to these issues, we ask that you post the following guidance for your clients:

• Primary care physicians: If the referral request rejects after several attempts, please direct the participating specialist to see the member as though a referral is on file. This issue should not prevent the member’s ability to seek care from participating specialists during this time.
• Participating specialists: If you’re participating in the member’s plan, try to inquire on a member’s referral. If you’re unable to find a referral, please see the member as though a referral is on file. When we receive the claim, we’ll adjudicate the claim as though the referral was on file. Contact the Member Services telephone number on the member’s ID card for help.

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