EFT and overpayment recovery

* Aetna’s overpayment recovery process does not change once you enroll in EFT.
*  We will only reverse an EFT deposit from your account in the instance of a duplicate or erroneous EFT. If an electronic debit is unsuccessful, or for deposit only accounts, Aetna will pursue settlement via alternate measures.

Medical claims vs. capitation

* EFT’s for medical claim payments are transmitted separately from capitation (CAP) and provider incentive
payment (PIP) payments.

EFT vs. paper checks

* Although providers are enrolled in EFT, approximately 5 percent of payments are still issued via a paper check.

Reasons for receiving paper EOBs and checks when enrolled in EFT:

1. EFT fails due to a change in bank account information that is not communicated to Aetna in advance.
2. Changes or additions to billing address information that is not communicated to Aetna in advance.
3. If a reissue of an EFT is required, the reissue will be in the form of a paper check.
4. If you have an EFT and the ERA file doesn’t appear in the ERA Inquiry Tool, then the ERA file is unable to be transmitted. We will attempt to fix the file, but if after 5 days this is not possible, a paper remittance is
printed and mailed.