Aetna

Aetna, a CVS Health company, is one of the largest U.S. health insurers, offering medical, dental, vision, pharmacy and Medicare/Medicaid plans to individuals, families, employers, health care providers and brokers. Its public API surface is entirely regulatory: Aetna operates an Interoperability API Developer Portal at developerportal.aetna.com that publishes HL7 FHIR R4 interfaces mandated by the CMS Interoperability and Patient Access Final Rule (CMS-9115-F) and the Advancing Interoperability and Improving Prior Authorization Final Rule (CMS-0057-F) - Patient Access, Payer to Payer, Provider Directory, Provider Access, Prior Authorization (Da Vinci CRD, PAS and CDex) and Realtime Pharmacy Benefit Check. Aetna publishes a machine-readable catalog of 139 operations and serves a Swagger 2.0 document for each one, plus live FHIR CapabilityStatements and SMART App Launch discovery documents on its production and sandbox FHIR gateways. Everything is read-only, everything requires OAuth 2.0 under SMART App Launch, and everything is free - there is no pricing, no plan and no metered product. Provider EDI connectivity is handled separately through the Availity portal.

Aetna publishes 3 APIs on the APIs.io network: Patient Access FHIR API, Provider Directory FHIR API, and Drug Formulary FHIR API. Tagged areas include Health Insurance, Healthcare, FHIR, Patient Access, and Provider Directory.

Aetna’s developer surface includes code examples, authentication, changelog, sandbox, documentation, API reference, getting-started guide, and 79 more developer resources.

🌐 Visit website 📡 Source on GitHub

47.5/100 developing ▬ flat Agent 42/100 agent native saas Full breakdown ↓
scored 2026-09-08 · rubric v0.20.0

AccessFreeSelf serve⚡ Free to try

95 APIs 6 Features 6 Use Cases

Health Insurance Healthcare FHIR Patient Access Provider Directory Drug Formulary Prior Authorization CMS Interoperability SMART on FHIR CARIN Blue Button Da Vinci Payer Fortune 100CVS Health

Kin Score

Kin Score How this is scored →
scored 2026-09-08 · rubric v0.20.0

Composite quality — 47.5/100 · developing

Contract Quality 8.1 / 21

Developer Ergonomics 7.2 / 17

Access Clarity 5.6 / 17

Operational Transparency 3.5 / 11

Contract Governance 3.4 / 10

Discoverability 6.3 / 9

Regulatory Posture 10.2 / 15

Agent readiness — 42/100 · agent native

Machine-Readable Contract 18 / 18

Agentic Access Contract 10 / 10

Documented Reversibility 6 / 6

MCP Server 0 / 12

Machine-Readable Auth 10 / 10

Idempotency 9 / 9

Stable Error Semantics 8 / 8

Request/Response Examples 7 / 7

Rate-Limit Signaling 7 / 7

Typed Event Surface 0 / 6

Agent Skills 5 / 5

Well-Known Catalog 0 / 4

Consent & Bot Identity 0 / 3

A2A Agent Card 0 / 8

Dry-Run / Simulate Mode 4 / 4

Delegated User Identity 6 / 6

Protected Resource Metadata 0 / 5

Registration Without a Human 0 / 6

Agentic Commerce Well-Known Document 0 / 5

Regulatory Posture applies to this provider. Its tags matched the Health regime, so Regulatory Posture carries 15 points of the composite. If this regime is wrong for your business, say so on your provider repo — the applicability map is public and we will correct it.

Create-or-Update Ergonomics does not apply to this provider. The published contracts declare no write operations, and a read-only API cannot create-or-update. The facet is excluded from this provider's denominator entirely — not scored zero. A reference or data API is not deficient for being unable to upsert.

The six quality facets above are damped to 85 points between them, because the conditional facet above carries the other 15. That is why each facet's contribution is shown against a damped maximum: raising a quality facet moves the composite by 85% of its nominal weight, not 100%. The full arithmetic is at apis.io/rating/.

Improve this rating by publishing the missing artifacts — every area above can be raised, and the full rubric is at apis.io/rating/. Every facet and dimension name above is a link: it opens that measurement's own page — what it means, the exact checks that feed it, how the whole catalog distributes on it, and the providers at the top of it. This rating is computed from github.com/api-evangelist/aetna: open an issue to ask a question, or submit a pull request to add artifacts. Submit an artifact on GitHub — free → Manage your own listing — the Influence plan, $499/mo →

APIs 7

Individual APIs this provider publishes, each with its own machine-readable definition.

Aetna Patient Access FHIR API

HL7 FHIR R4 Patient Access API giving Aetna members, through an app they authorize, access to their adjudicated claims, encounter data, coverage, clinical records and formulary ...

Aetna Provider Directory FHIR API

HL7 FHIR R4 Provider Directory API implementing the Da Vinci PDex Plan Net Implementation Guide (upgraded to version 1.2.0 on 2026-06-23), covering both Medicare and Commercial ...

Aetna Drug Formulary FHIR API

Da Vinci PDex US Drug Formulary 2.0.0 STU 2 formulary data, delivered as part of the Patient Access API product rather than as a separate base URL. MedicationKnowledge carries c...

Aetna Prior Authorization FHIR API

Da Vinci prior-authorization surface built for CMS-0057-F: Coverage Requirements Discovery (STU 2.1) at /coveragerequirementsdiscovery/v1/cds-services/{id} supporting the order-...

Aetna Provider Access FHIR API

Launched in Production on 2026-03-27 under the public-provider-group-fhir product, the Provider Access API lets provider organizations and EHR vendors identify their attributed ...

Aetna Realtime Pharmacy Benefit Check API

Consumer Real-Time Pharmacy Benefit Check 1.0.0, launched 2024-12-05, letting members and EHR systems retrieve prescription drug cost and coverage information at the point of pr...

Aetna Provider EDI Connectivity

HIPAA X12 electronic data interchange for health care professionals - EDI 837 claims, 270/271 eligibility and benefits, 276/277 claim status and 835 remittance advice. This is n...

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GraphQL 1

GraphQL schemas published by this provider.

Aetna GraphQL Schema

> **NOT A PROVIDER CONTRACT — DO NOT PUBLISH, SCORE OR GENERATE CLIENTS FROM THIS FILE.**

GRAPHQL

Pricing Plans 1

Published pricing tiers and plan structures.

Aetna Plans Pricing

0 plans

PLANS

Rate Limits 1

Documented rate limits and quota policies.

Aetna Rate Limits

0 limits

RATE LIMITS

FinOps 1

Cost, billing, and metering signals for API financial operations.

Aetna Finops

FINOPS

Features 6

Notable capabilities this provider offers.

FHIR R4 Compliance

All patient-facing APIs implement HL7 FHIR Release 4 standard for interoperability.

SMART on FHIR Authorization

Secure OAuth 2.0 authorization framework for patient-authorized third-party app access.

CMS Interoperability Compliance

Full compliance with CMS-9115-F Interoperability and Patient Access Final Rule.

EDI Transaction Support

Complete HIPAA-compliant EDI transaction set for provider administrative workflows.

Payer-to-Payer Data Exchange

Supports member-directed payer-to-payer data exchange for continuity of care.

DaVinci Implementation Guides

Implements HL7 DaVinci Project PDEX, PDex Drug Formulary, and Plan Net guides.

JSON Schema 25

Standalone JSON Schema definitions for this provider's data models.

Aetna FHIR R4 AllergyIntolerance

0 properties

JSON SCHEMA

Aetna FHIR R4 Bundle

0 properties

JSON SCHEMA

Aetna FHIR R4 CarePlan

0 properties

JSON SCHEMA

Aetna FHIR R4 CareTeam

0 properties

JSON SCHEMA

Aetna FHIR R4 Condition

0 properties

JSON SCHEMA

Aetna FHIR R4 Device

0 properties

JSON SCHEMA

Aetna FHIR R4 DiagnosticReport

0 properties

JSON SCHEMA

Aetna FHIR R4 DocumentReference

0 properties

JSON SCHEMA

Aetna FHIR R4 Encounter

0 properties

JSON SCHEMA

Aetna FHIR R4 ExplanationOfBenefit

0 properties

JSON SCHEMA

Aetna FHIR R4 Goal

0 properties

JSON SCHEMA

Aetna FHIR R4 HealthcareService

0 properties

JSON SCHEMA

Aetna FHIR R4 Immunization

0 properties

JSON SCHEMA

Aetna FHIR R4 InsurancePlan

0 properties

JSON SCHEMA

Aetna FHIR R4 Location

0 properties

JSON SCHEMA

Aetna FHIR R4 MedicationKnowledge

0 properties

JSON SCHEMA

Aetna FHIR R4 MedicationRequest

0 properties

JSON SCHEMA

Aetna FHIR R4 Observation

48 properties

JSON SCHEMA

Aetna FHIR R4 OperationOutcome

0 properties

JSON SCHEMA

Aetna FHIR R4 Organization

0 properties

JSON SCHEMA

Aetna FHIR R4 OrganizationAffiliation

0 properties

JSON SCHEMA

Aetna FHIR R4 Patient

0 properties

JSON SCHEMA

Aetna FHIR R4 Practitioner

0 properties

JSON SCHEMA

Aetna FHIR R4 PractitionerRole

0 properties

JSON SCHEMA

Aetna FHIR R4 Procedure

0 properties

JSON SCHEMA

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Examples 70

Example request and response payloads for these APIs.

Aetna V1 Providerdirectory Insuranceplan 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Insuranceplan 400 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Insuranceplan 500 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Location 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Location 400 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Location 500 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Location Id 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Location Id 400 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Location Id 404 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Location Id 500 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Organization 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Organization 400 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Organization 500 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Organization Id 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Organization Id 203 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Organization Id 400 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Organization Id 404 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Organization Id 500 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Organizationaffiliation 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Organizationaffiliation 400 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Organizationaffiliation 500 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Practitioner 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Practitioner 400 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Practitioner 500 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Practitioner Id 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Practitioner Id 203 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectory Practitionerrole 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectorydata Healthcareservice 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectorydata Healthcareservice Id 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectorydata Insuranceplan 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectorydata Location 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectorydata Location Id 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectorydata Organization 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectorydata Organization Id 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectorydata Organizationaffiliation 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectorydata Practitioner 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectorydata Practitioner Id 200 Example

2 fields

EXAMPLE

Aetna V1 Providerdirectorydata Practitionerrole 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Allergyintolerance 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Allergyintolerance Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Careplan 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Careplan Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Careteam 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Condition 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Condition Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Device 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Device Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Diagnosticreport 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Diagnosticreport Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Documentreference 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Documentreference Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Encounter 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Encounter Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Explanationofbenefit Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Goal 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Goal Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Immunization 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Immunization Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Medication Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Medicationknowledge 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Medicationknowledge Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Medicationrequest 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Medicationrequest Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Observation 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Observation Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Organization Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Practitioner Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Practitionerrole Id 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Procedure 200 Example

2 fields

EXAMPLE

Aetna V2 Patientaccess Procedure Id 200 Example

2 fields

EXAMPLE

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Security Posture 2

Authentication, domain security, vulnerability disclosure, and trust-center signals.

Aetna Authentication

oauth2 · 2 schemes

SECURITY

Aetna Domain Security

TLSv1.3 · DMARC

SECURITY

Scopes 1

OAuth scopes governing access to this provider's APIs.

Aetna Scopes

54 scopes · authorizationCode/clientCredentials

54 scopes

SCOPES

Agentic Access 1

Recommended x-agentic-access execution contracts for AI agents.

Aetna Agentic Access

99 operations

99 operations · 0 acting

AGENTIC

Use Cases 6

What developers build with this provider.

Member Health Record Access

Members use SMART on FHIR apps to access their complete health records across providers.

Provider Network Verification

Developers build directory search tools to help patients find in-network providers.

Drug Cost Comparison

Applications use formulary API to compare medication costs across Aetna plans.

Electronic Claims Submission

Healthcare providers submit claims electronically via EDI 837 transactions through Availity.

Eligibility Verification

Providers verify member eligibility and benefits in real time using 270/271 EDI transactions.

Remittance Processing

Providers receive and process electronic remittance advice via EDI 835 transactions.

Integrations 6

Pre-built integrations with other platforms and tools.

CVS Caremark

Integrated pharmacy benefit management for prescription drug coverage and mail-order pharmacy.

Availity

Primary provider portal for EDI transactions, eligibility, claims, and authorization requests.

Epic Payer Platform

EHR integration enabling clinical workflows including prior authorization and care management.

Apple Health

FHIR-based integration enabling Aetna members to view health data in Apple Health app.

CommonWell Health Alliance

Interoperability network participation for cross-organization health data exchange.

CMS Blue Button 2.0

Alignment with CMS Blue Button 2.0 FHIR API patterns for Medicare data access.

Press 5

Recent news and press coverage referencing this provider.

Aetna taps into AI with Care Paths tech

2026-05-25

Aetna launches leading edge conversational AI navigation

2026-05-25

Aetna launches conversational AI for health care navigation

2026-05-25

Aetna expands initiatives to simplify experiences for health ...

2026-05-25

Aetna Launches New AI and Digital Tools to Improve ...

2026-05-25

Resources

Get Started 6

Portal, sign-up, and the first successful call

Sandbox

DeveloperPortal

GettingStarted

SignUp

Login

Portal

Portal

Documentation 29

Reference material describing how the API behaves

OpenAPI

OpenAPI

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

JSONSchema

Documentation

APIReference

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Agent Surfaces 5

MCP servers, agent skills, and machine-readable catalogs

X-MCPServerCandidate

AgentSkill

LLMsTxt

WellKnown

AgenticAccess

Design & Contract 6

Pagination, idempotency, versioning, errors, and events

Vocabulary

Conformance

ErrorCatalog

Conventions

Lifecycle

DataModel

Build 22

SDKs, sample code, and the tooling you integrate with

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Examples

Packages

GitHubOrganization

GitHubOrganization

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Access & Security 4

Authentication, authorization, and security posture

Authentication

OAuthScopes

Compliance

DomainSecurity

Operate 6

Status, limits, changes, and where to get help

Deprecation

ChangeLog

ChangeLog

Roadmap

RateLimits

Support

Commercial 4

Pricing, plans, and the legal terms of use

Plans

FinOps

PrivacyPolicy

TermsOfService

Company 2

The organization behind the API

Website

Website

LinkedIn

Other 2

Properties that don't map to a standard resource type

Overlay

Overlay

CapabilityStatement

CapabilityStatement

Source (apis.yml)

aid: aetna
deliveryModel:
  model: saas
  open_source: false
  commercial: true
  callable_host: false
  label: Hosted service · you call their endpoint
  confidence: medium
  source:
  - pricing
  generated: '2026-08-30'
  method: derived
specificationVersion: '0.23'
accessModel:
  pricing: free
  onboarding: self-serve
  trial: false
  try_now: true
  public: false
  label: Free · Self-serve signup
  confidence: high
  source:
  - finops
  - authentication
  - scopes
  - rate-limits
  - security
  - sandbox
  generated: '2026-08-30'
  method: derived
image: https://kinlane-images.s3.amazonaws.com/shared/apis-json/icons/aetna.png
url: https://raw.githubusercontent.com/api-evangelist/aetna/refs/heads/main/apis.yml
modified: '2026-08-30'
name: Aetna
description: 'Aetna, a CVS Health company, is one of the largest U.S. health insurers, offering medical, dental, vision, pharmacy
  and Medicare/Medicaid plans to individuals, families, employers, health care providers and brokers. Its public API surface
  is entirely regulatory: Aetna operates an Interoperability API Developer Portal at developerportal.aetna.com that publishes
  HL7 FHIR R4 interfaces mandated by the CMS Interoperability and Patient Access Final Rule (CMS-9115-F) and the Advancing
  Interoperability and Improving Prior Authorization Final Rule (CMS-0057-F) - Patient Access, Payer to Payer, Provider Directory,
  Provider Access, Prior Authorization (Da Vinci CRD, PAS and CDex) and Realtime Pharmacy Benefit Check. Aetna publishes a
  machine-readable catalog of 139 operations and serves a Swagger 2.0 document for each one, plus live FHIR CapabilityStatements
  and SMART App Launch discovery documents on its production and sandbox FHIR gateways. Everything is read-only, everything
  requires OAuth 2.0 under SMART App Launch, and everything is free - there is no pricing, no plan and no metered product.
  Provider EDI connectivity is handled separately through the Availity portal.'
tags:
- Health Insurance
- Healthcare
- FHIR
- Patient Access
- Provider Directory
- Drug Formulary
- Prior Authorization
- CMS Interoperability
- SMART on FHIR
- CARIN Blue Button
- Da Vinci
- Payer
- Fortune 100
- CVS Health
apis:
- aid: aetna-patient-access-fhir-api
  name: Aetna Patient Access FHIR API
  description: HL7 FHIR R4 Patient Access API giving Aetna members, through an app they authorize, access to their adjudicated
    claims, encounter data, coverage, clinical records and formulary information. Implements the CARIN for Blue Button framework
    (v1.0.0 and v2.0.0) and US Core (3.1.1, 5.0.1 and 6.1.0 depending on the resource), required under CMS-9115-F. Secured
    with SMART App Launch 1.0.0 OAuth 2.0 authorization code with PKCE and a member-bound patient context. Exposes Patient,
    Coverage, ExplanationOfBenefit, Condition, Encounter, Observation, Procedure, MedicationRequest, MedicationKnowledge,
    DocumentReference, CarePlan, CareTeam, Goal, AllergyIntolerance, Immunization, DiagnosticReport, Device, Binary and Endpoint.
    The same operations back the Payer to Payer API used by another payer for member-directed data exchange.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apif1.aetna.com/fhir
  tags:
  - FHIR
  - Patient Access
  - CARIN Blue Button
  - US Core
  - Claims
  - Coverage
  - SMART on FHIR
  - CMS Mandate
  properties:
  - type: OpenAPI
    url: openapi/aetna-patient-access-api-openapi.yml
  - type: OpenAPI
    url: openapi/aetna-patient-access-api-sandbox-openapi.yml
  - type: Overlay
    url: overlays/aetna-patient-access-api-overlay.yaml
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v2/patientaccess/metadata
  - type: Documentation
    url: https://www.aetna.com/individuals-families/member-rights-resources/rights/state-specific-information/access-your-health-data.html
  - type: DeveloperPortal
    url: https://developerportal.aetna.com/
  - type: Authentication
    url: authentication/aetna-authentication.yml
  - type: CapabilityStatement
    url: fhir/aetna-patient-access-capability-statement.json
  - type: Examples
    url: examples/
- aid: aetna-provider-directory-fhir-api
  name: Aetna Provider Directory FHIR API
  description: HL7 FHIR R4 Provider Directory API implementing the Da Vinci PDex Plan Net Implementation Guide (upgraded to
    version 1.2.0 on 2026-06-23), covering both Medicare and Commercial networks. Exposes Practitioner, PractitionerRole,
    Organization, OrganizationAffiliation, InsurancePlan, Location and HealthcareService across two surfaces - an interactive
    directory at /v1/providerdirectory and a data surface at /v1/providerdirectorydata that additionally offers Bulk FHIR
    $export and $exportstatus. Unlike several peer payers, Aetna requires OAuth on the directory; it is not anonymously callable.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apif1.aetna.com/fhir
  tags:
  - FHIR
  - Provider Directory
  - Da Vinci
  - PDex Plan Net
  - Bulk FHIR
  - Network
  - CMS Mandate
  properties:
  - type: OpenAPI
    url: openapi/aetna-provider-directory-api-openapi.yml
  - type: Overlay
    url: overlays/aetna-provider-directory-api-overlay.yaml
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v1/providerdirectory/metadata
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: DeveloperPortal
    url: https://developerportal.aetna.com/
  - type: Authentication
    url: authentication/aetna-authentication.yml
  - type: CapabilityStatement
    url: fhir/aetna-provider-directory-capability-statement.json
- aid: aetna-drug-formulary-fhir-api
  name: Aetna Drug Formulary FHIR API
  description: Da Vinci PDex US Drug Formulary 2.0.0 STU 2 formulary data, delivered as part of the Patient Access API product
    rather than as a separate base URL. MedicationKnowledge carries covered drugs, tiers, cost sharing and restrictions such
    as prior authorization and step therapy; formulary InsurancePlan, Basic and Location resources were added on 2024-04-19
    when the older List API was decommissioned.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apif1.aetna.com/fhir
  tags:
  - FHIR
  - Drug Formulary
  - Da Vinci
  - Pharmacy
  - MedicationKnowledge
  - CMS Mandate
  properties:
  - type: OpenAPI
    url: openapi/aetna-patient-access-api-openapi.yml
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v2/patientaccess/metadata
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: DeveloperPortal
    url: https://developerportal.aetna.com/
- aid: aetna-prior-authorization-fhir-api
  name: Aetna Prior Authorization FHIR API
  description: 'Da Vinci prior-authorization surface built for CMS-0057-F: Coverage Requirements Discovery (STU 2.1) at /coveragerequirementsdiscovery/v1/cds-services/{id}
    supporting the order-sign, order-dispatch and appointment-book CDS Hooks; Prior Authorization Support (STU 2.1) at /priorauthorizationsupport/v1/Claim/$submit
    and /$inquire; and Clinical Data Exchange (CDex STU 2.1.0) at /clinicaldataexchange/v1/$submit-attachment. Aetna states
    that Meritain members, Medicaid members, pharmacy prior authorization and SNOMED procedure codes are not supported. Production
    traffic for these products moved to the apix.cvshealth.com host on 2026-03-04. Every spec document for this API returned
    HTTP 403 when this repo was harvested, so no machine-readable contract for it is held here.'
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apix.cvshealth.com
  tags:
  - FHIR
  - Prior Authorization
  - Da Vinci
  - CDS Hooks
  - CRD
  - PAS
  - CDex
  - CMS-0057-F
  properties:
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: DeveloperPortal
    url: https://developerportal.aetna.com/
  - type: APIReference
    url: https://developerportal.aetna.com/assets/Data/Fhir.json
- aid: aetna-provider-access-fhir-api
  name: Aetna Provider Access FHIR API
  description: Launched in Production on 2026-03-27 under the public-provider-group-fhir product, the Provider Access API
    lets provider organizations and EHR vendors identify their attributed member groups and request a bulk data export for
    treatment purposes. Operations cover /provideraccess/v1/Group, /Group/{id}, /Group/$exportstatus/{id}, /Group/{id}/$davinci-data-export
    and /Group/ExportFile/{fileId}, implementing Da Vinci PDex STU 2.1.0 with Bulk Data Access IG STU 3.0.0. A dedicated ECS
    Provider role was added 2026-08-19.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apif1.aetna.com/fhir
  tags:
  - FHIR
  - Provider Access
  - Da Vinci
  - Bulk FHIR
  - Member Attribution
  - CMS-0057-F
  properties:
  - type: Documentation
    url: https://www.aetna.com/individuals-families/member-rights-resources/rights/state-specific-information/provider-access-options.html
  - type: DeveloperPortal
    url: https://developerportal.aetna.com/
  - type: APIReference
    url: https://developerportal.aetna.com/assets/Data/Fhir.json
- aid: aetna-realtime-pharmacy-benefit-check-api
  name: Aetna Realtime Pharmacy Benefit Check API
  description: Consumer Real-Time Pharmacy Benefit Check 1.0.0, launched 2024-12-05, letting members and EHR systems retrieve
    prescription drug cost and coverage information at the point of prescribing. Built to satisfy California AB 2352 and Texas
    HB 0662H. Exposed as a FHIR messaging operation at /v1/realtimepharmacybenefitcheck/$process-message (member-facing) and
    /realtimepharmacybenefitcheck/v1/$process-message (provider-facing). Production traffic moved to the apix.cvshealth.com
    host on 2026-03-04. Spec documents returned HTTP 403 to this harvest.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apix.cvshealth.com
  tags:
  - FHIR
  - Pharmacy
  - Real-Time Benefit Check
  - RTPBC
  - Prescription Cost
  properties:
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: DeveloperPortal
    url: https://developerportal.aetna.com/
  - type: APIReference
    url: https://developerportal.aetna.com/assets/Data/Fhir.json
- aid: aetna-provider-edi-api
  name: Aetna Provider EDI Connectivity
  description: HIPAA X12 electronic data interchange for health care professionals - EDI 837 claims, 270/271 eligibility and
    benefits, 276/277 claim status and 835 remittance advice. This is not an Aetna-hosted REST API and Aetna publishes no
    machine-readable contract for it; connectivity runs through the Availity provider portal and through clearinghouses, against
    the ASC X12 5010 and NCPDP D.0 transaction standards Aetna documents on aetna.com.
  humanURL: https://www.aetna.com/health-care-professionals/availity.html
  baseURL: https://www.availity.com
  tags:
  - EDI
  - X12
  - HIPAA
  - Claims
  - Eligibility
  - Remittance
  - Availity
  - Clearinghouse
  properties:
  - type: Documentation
    url: https://www.aetna.com/health-care-professionals/claims-payment-reimbursement/electronic-claims.html
  - type: Portal
    url: https://www.aetna.com/health-care-professionals/availity.html
  - type: Conformance
    url: https://www.aetna.com/health-care-professionals/icd-10-5010-npi-information/5010-d0-transaction-standards.html
common:
- type: OpenAPI
  url: openapi/aetna-patient-access-api-openapi.yml
- type: OpenAPI
  url: openapi/aetna-provider-directory-api-openapi.yml
- type: Overlay
  url: overlays/aetna-patient-access-api-overlay.yaml
- type: CapabilityStatement
  url: fhir/aetna-patient-access-capability-statement.json
- type: Vocabulary
  url: vocabulary/aetna-vocabulary.yaml
- type: JSONSchema
  url: json-schema/aetna-allergyintolerance.json
- type: JSONSchema
  url: json-schema/aetna-bundle.json
- type: JSONSchema
  url: json-schema/aetna-careplan.json
- type: JSONSchema
  url: json-schema/aetna-careteam.json
- type: JSONSchema
  url: json-schema/aetna-condition.json
- type: JSONSchema
  url: json-schema/aetna-device.json
- type: JSONSchema
  url: json-schema/aetna-diagnosticreport.json
- type: JSONSchema
  url: json-schema/aetna-documentreference.json
- type: JSONSchema
  url: json-schema/aetna-encounter.json
- type: JSONSchema
  url: json-schema/aetna-explanationofbenefit.json
- type: JSONSchema
  url: json-schema/aetna-goal.json
- type: JSONSchema
  url: json-schema/aetna-healthcareservice.json
- type: JSONSchema
  url: json-schema/aetna-immunization.json
- type: JSONSchema
  url: json-schema/aetna-insuranceplan.json
- type: JSONSchema
  url: json-schema/aetna-location.json
- type: JSONSchema
  url: json-schema/aetna-medicationknowledge.json
- type: JSONSchema
  url: json-schema/aetna-medicationrequest.json
- type: JSONSchema
  url: json-schema/aetna-observation.json
- type: JSONSchema
  url: json-schema/aetna-operationoutcome.json
- type: JSONSchema
  url: json-schema/aetna-organization.json
- type: JSONSchema
  url: json-schema/aetna-organizationaffiliation.json
- type: JSONSchema
  url: json-schema/aetna-patient.json
- type: JSONSchema
  url: json-schema/aetna-practitioner.json
- type: JSONSchema
  url: json-schema/aetna-practitionerrole.json
- type: JSONSchema
  url: json-schema/aetna-procedure.json
- type: Examples
  url: examples/aetna-v1-providerdirectory-insuranceplan-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectory-location-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectory-location-id-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectory-organization-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectory-organization-id-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectory-organizationaffiliation-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectory-practitioner-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectory-practitioner-id-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectory-practitionerrole-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectorydata-healthcareservice-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectorydata-healthcareservice-id-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectorydata-insuranceplan-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectorydata-location-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectorydata-location-id-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectorydata-organization-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectorydata-organization-id-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectorydata-organizationaffiliation-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectorydata-practitioner-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectorydata-practitioner-id-200-example.json
- type: Examples
  url: examples/aetna-v1-providerdirectorydata-practitionerrole-200-example.json
- type: Authentication
  url: authentication/aetna-authentication.yml
- type: OAuthScopes
  url: scopes/aetna-scopes.yml
- type: Conformance
  url: conformance/aetna-conformance.yml
- type: Compliance
  url: conformance/aetna-conformance.yml
- type: ErrorCatalog
  url: errors/aetna-problem-types.yml
- type: Conventions
  url: conventions/aetna-conventions.yml
- type: Lifecycle
  url: lifecycle/aetna-lifecycle.yml
- type: Deprecation
  url: https://developerportal.aetna.com/managedcontent/pdfs/Previous_Releases.pdf
- type: ChangeLog
  url: changelog/aetna-changelog.yml
- type: ChangeLog
  url: https://developerportal.aetna.com/managedcontent/pdfs/Previous_Releases.pdf
- type: Roadmap
  url: https://developerportal.aetna.com/managedcontent/pdfs/Upcoming_Releases.pdf
- type: Sandbox
  url: sandbox/aetna-sandbox.yml
- type: DataModel
  url: data-model/aetna-data-model.yml
- type: RateLimits
  url: rate-limits/aetna-rate-limits.yml
- type: Plans
  url: plans/aetna-plans-pricing.yml
- type: Packages
  url: packages/aetna-packages.yml
- type: X-MCPServerCandidate
  url: mcp/aetna-mcp.yml
  note: 'Renamed from MCPServer 2026-09-03 (roadmap#247): the manifest self-describes as status: candidate — a tool list derived
    from the published API contracts, not an existing server. The scorer already read the manifest and reported mcp_server
    correctly; the MCPServer type was crediting the artifact-type surfaces with a server that does not exist.'
- type: AgentSkill
  url: skills/_index.yml
- type: LLMsTxt
  url: llms/aetna-llms.txt
- type: WellKnown
  url: well-known/aetna-well-known.yml
- type: AgenticAccess
  url: agentic-access/aetna-agentic-access.yml
- type: DomainSecurity
  url: security/aetna-domain-security.yml
- type: FinOps
  url: finops/aetna-finops.yml
- type: DeveloperPortal
  url: https://developerportal.aetna.com/
- type: Documentation
  url: https://developerportal.aetna.com/
- type: APIReference
  url: https://developerportal.aetna.com/assets/Data/Fhir.json
- type: GettingStarted
  url: https://developerportal.aetna.com/gettingstarted/1000
- type: SignUp
  url: https://developerportal.aetna.com/
- type: Login
  url: https://member.aetna.com
- type: Support
  url: https://www.aetna.com/individuals-families/contact-aetna.html
- type: Website
  url: https://www.aetna.com
- type: Portal
  url: https://www.aetna.com/health-care-professionals.html
- type: GitHubOrganization
  url: https://github.com/aetnahealth
- type: LinkedIn
  url: https://www.linkedin.com/company/aetna
- type: PrivacyPolicy
  url: https://www.aetna.com/legal-notices/privacy.html
- type: TermsOfService
  url: https://developerportal.aetna.com/termsofuse
- type: Features
  data:
  - name: FHIR R4 Compliance
    description: All patient-facing APIs implement HL7 FHIR Release 4 standard for interoperability.
  - name: SMART on FHIR Authorization
    description: Secure OAuth 2.0 authorization framework for patient-authorized third-party app access.
  - name: CMS Interoperability Compliance
    description: Full compliance with CMS-9115-F Interoperability and Patient Access Final Rule.
  - name: EDI Transaction Support
    description: Complete HIPAA-compliant EDI transaction set for provider administrative workflows.
  - name: Payer-to-Payer Data Exchange
    description: Supports member-directed payer-to-payer data exchange for continuity of care.
  - name: DaVinci Implementation Guides
    description: Implements HL7 DaVinci Project PDEX, PDex Drug Formulary, and Plan Net guides.
- type: UseCases
  data:
  - name: Member Health Record Access
    description: Members use SMART on FHIR apps to access their complete health records across providers.
  - name: Provider Network Verification
    description: Developers build directory search tools to help patients find in-network providers.
  - name: Drug Cost Comparison
    description: Applications use formulary API to compare medication costs across Aetna plans.
  - name: Electronic Claims Submission
    description: Healthcare providers submit claims electronically via EDI 837 transactions through Availity.
  - name: Eligibility Verification
    description: Providers verify member eligibility and benefits in real time using 270/271 EDI transactions.
  - name: Remittance Processing
    description: Providers receive and process electronic remittance advice via EDI 835 transactions.
- type: Integrations
  data:
  - name: CVS Caremark
    description: Integrated pharmacy benefit management for prescription drug coverage and mail-order pharmacy.
  - name: Availity
    description: Primary provider portal for EDI transactions, eligibility, claims, and authorization requests.
  - name: Epic Payer Platform
    description: EHR integration enabling clinical workflows including prior authorization and care management.
  - name: Apple Health
    description: FHIR-based integration enabling Aetna members to view health data in Apple Health app.
  - name: CommonWell Health Alliance
    description: Interoperability network participation for cross-organization health data exchange.
  - name: CMS Blue Button 2.0
    description: Alignment with CMS Blue Button 2.0 FHIR API patterns for Medicare data access.
created: '2026-05-04'
maintainers:
- FN: API Evangelist
  email: info@apievangelist.com
x-enrichment:
  date: '2026-08-30'
  status: enriched
  artifacts_added: 219
  artifacts_updated: 6
  pass: local-v1
  headline: Aetna was previously recorded with no machine-readable contract. It publishes 139 of them. The developer portal
    is an Angular SPA that serves an HTML shell on every route, which is why earlier rounds missed it; its own JavaScript
    loads a machine-readable API catalog at https://developerportal.aetna.com/assets/Data/Fhir.json, and each entry names
    a Swagger 2.0 file served from https://developerportal.aetna.com/managedcontent/yaml/. 95 of the 138 named files were
    retrieved (43 returned Akamai 403). Two live FHIR CapabilityStatements and two SMART App Launch discovery documents were
    also captured. A fabricated 'conceptual' GraphQL schema from an earlier round was demoted and its apis.yml pointer removed;
    Aetna ships no GraphQL API.
  pointer_checks:
    checked: '2026-08-30'
    method: GET with a browser User-Agent, following redirects
    removed_confirmed_dead:
    - url: https://www.aetna.com/individuals-families/member-rights-resources/member-data-access.html
      status: 404
    - url: https://www.aetna.com/health-care-professionals/working-with-aetna/provider-directory.html
      status: 404
    - url: https://www.aetna.com/health-care-professionals/claims-payment/claims-submission.html
      status: 404
    - url: https://www.aetna.com/legal-notices/terms-of-use.html
      status: 404
    - url: graphql/aetna-graphql.md
      status: removed - fabricated conceptual schema, not a provider contract
    verified_live:
    - url: https://www.aetna.com
      status: 200
    - url: https://www.aetna.com/health-care-professionals.html
      status: 200
    - url: https://www.aetna.com/individuals-families/contact-aetna.html
      status: 200
    - url: https://www.aetna.com/legal-notices/privacy.html
      status: 200
    - url: https://www.aetna.com/individuals-families/member-rights-resources/rights/state-specific-information/access-your-health-data.html
      status: 200
    - url: https://www.aetna.com/individuals-families/member-rights-resources/rights/state-specific-information/provider-access-options.html
      status: 200
    - url: https://www.aetna.com/health-care-professionals/availity.html
      status: 200
    - url: https://www.aetna.com/health-care-professionals/claims-payment-reimbursement/electronic-claims.html
      status: 200
    - url: https://www.aetna.com/health-care-professionals/icd-10-5010-npi-information/5010-d0-transaction-standards.html
      status: 200
    - url: https://member.aetna.com
      status: 200
    - url: https://news.aetna.com
      status: 200
    - url: https://github.com/aetnahealth
      status: 200
    - url: https://www.linkedin.com/company/aetna
      status: 200
    - url: https://www.availity.com
      status: 200
    - url: https://developerportal.aetna.com/
      status: 200
    - url: https://developerportal.aetna.com/assets/Data/Fhir.json
      status: 200
    - url: https://apif1.aetna.com/fhir/v2/patientaccess/metadata
      status: 200
    - url: https://apif1.aetna.com/fhir/v1/providerdirectory/metadata
      status: 200
    - url: https://apif1.aetna.com/fhir/.well-known/smart-configuration
      status: 200
    - url: https://developerportal.aetna.com/managedcontent/pdfs/Previous_Releases.pdf
      status: 200
    spa_caveat: 'developerportal.aetna.com is an Angular single-page app: every route, including a deliberate control probe
      at /definitely-not-a-real-route-control-probe, returns the same 1,055-byte HTML shell with HTTP 200. Route-level pointers
      (/gettingstarted/1000, /termsofuse) therefore cannot be confirmed by status code. They are emitted because search engines
      have indexed each one with its own distinct title (''Aetna Interoperability API Developer Portal Terms and ...''), which
      is independent evidence the route renders real content client-side.'
    unverifiable:
    - url: https://developerportal.aetna.com/managedcontent/pdfs/Upcoming_Releases.pdf
      status: 403
      note: Akamai edge denial to this run's IP after a burst of spec downloads. NOT confirmed dead - the portal's own main.js
        references this exact path alongside Previous_Releases.pdf, which did return 200. Emitted as the Roadmap pointer.
x-parent: cvs-health
x-relationship: acquisition
x-acquired: 2018

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