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 15 APIs on the APIs.io network, including Endpoint API, Location API, Organization API, and 12 more. 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 80 more developer resources.

45.6/100 developing ▬ flat Agent 42/100 agent native Front door AI 1/6 silent saas Full breakdown ↓
scored 2026-09-25 · rubric v0.23.0
AccessFreeSelf serve⚡ Free to try
96 APIs 6 Features 6 Use Cases
Health InsuranceHealthcareFHIRPatient AccessProvider DirectoryDrug FormularyPrior AuthorizationCMS InteroperabilitySMART on FHIRCARIN Blue ButtonDa VinciPayersFortune 100CVS Health

Kin Score

Kin Score Kin Score How this is scored →
scored 2026-09-25 · rubric v0.23.0
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 15

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

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...

Aetna Endpoint API

The Endpoint API from Aetna — 2 operation(s) for endpoint.

Aetna Location API

The Location API from Aetna — 2 operation(s) for location.

Aetna Organization API

The Organization API from Aetna — 2 operation(s) for organization.

Aetna Organization Affiliation API

The OrganizationAffiliation API from Aetna — 1 operation(s) for organizationaffiliation.

Aetna Practitioner API

The Practitioner API from Aetna — 2 operation(s) for practitioner.

Aetna Providerdirectorydata API

The Providerdirectorydata API from Aetna — 11 operation(s) for providerdirectorydata.

Aetna Patient Access API

The Patient Access API from Aetna — 83 operation(s) for patient access.

Aetna Provider Directory API

The Provider Directory API from Aetna — 9 operation(s) for provider directory.

Aetna Healthcare Service API

The Healthcare Service API from Aetna — 2 operation(s) for healthcare service.

Aetna Insurance Plan API

The Insurance Plan API from Aetna — 1 operation(s) for insurance plan.

Aetna Practitioner Role API

The Practitioner Role API from Aetna — 1 operation(s) for practitioner role.

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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

Scroll for all 25

Examples 70

Example request and response payloads for these APIs.

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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

Aetna launches leading edge conversational AI navigation

Aetna launches conversational AI for health care navigation

Aetna expands initiatives to simplify experiences for health ...

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

Resources

Get Started 6

Portal, sign-up, and the first successful call

Documentation 29

Reference material describing how the API behaves

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Agent Surfaces 5

MCP servers, agent skills, and machine-readable catalogs

Design & Contract 6

Pagination, idempotency, versioning, errors, and events

Build 22

SDKs, sample code, and the tooling you integrate with

Scroll for all 22

Access & Security 4

Authentication, authorization, and security posture

Operate 6

Status, limits, changes, and where to get help

Commercial 4

Pricing, plans, and the legal terms of use

Company 2

The organization behind the API

Other 3

Properties that don't map to a standard resource type

Source (apis.yml)

apis.yml Raw ↑
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
- Payers
- Fortune 100
- CVS Health
tags_raw:
- 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: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/$submit-attachment. Aetna states
    that Meritain members, Medicaid members, pharmacy prior authorization and SNOMED procedure codes are not supported. Production
    traffic for these products moved to the apix.cvshealth.com host on 2026-03-04. Every spec document for this API returned
    HTTP 403 when this repo was harvested, so no machine-readable contract for it is held here.'
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apix.cvshealth.com
  tags:
  - FHIR
  - Prior Authorization
  - Da Vinci
  - CDS Hooks
  - CRD
  - PAS
  - CDex
  - CMS-0057-F
  properties:
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: DeveloperPortal
    url: https://developerportal.aetna.com/
  - type: APIReference
    url: https://developerportal.aetna.com/assets/Data/Fhir.json
- aid: aetna:aetna-provider-access-fhir-api
  name: Aetna Provider Access FHIR API
  description: Launched in Production on 2026-03-27 under the public-provider-group-fhir product, the Provider Access API
    lets provider organizations and EHR vendors identify their attributed member groups and request a bulk data export for
    treatment purposes. Operations cover /provideraccess/v1/Group, /Group/{id}, /Group/$exportstatus/{id}, /Group/{id}/$davinci-data-export
    and /Group/ExportFile/{fileId}, implementing Da Vinci PDex STU 2.1.0 with Bulk Data Access IG STU 3.0.0. A dedicated ECS
    Provider role was added 2026-08-19.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apif1.aetna.com/fhir
  tags:
  - FHIR
  - Provider Access
  - Da Vinci
  - Bulk FHIR
  - Member Attribution
  - CMS-0057-F
  properties:
  - type: Documentation
    url: https://www.aetna.com/individuals-families/member-rights-resources/rights/state-specific-information/provider-access-options.html
  - type: DeveloperPortal
    url: https://developerportal.aetna.com/
  - type: APIReference
    url: https://developerportal.aetna.com/assets/Data/Fhir.json
- aid: aetna:aetna-realtime-pharmacy-benefit-check-api
  name: Aetna Realtime Pharmacy Benefit Check API
  description: Consumer Real-Time Pharmacy Benefit Check 1.0.0, launched 2024-12-05, letting members and EHR systems retrieve
    prescription drug cost and coverage information at the point of prescribing. Built to satisfy California AB 2352 and Texas
    HB 0662H. Exposed as a FHIR messaging operation at /v1/realtimepharmacybenefitcheck/$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: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
  - Remittances
  - Availity
  - Clearinghouse
  tags_raw:
  - 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
- aid: aetna:aetna-endpoint-api
  name: Aetna Endpoint API
  description: The Endpoint API from Aetna — 2 operation(s) for endpoint.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apif1.aetna.com/fhir
  tags: []
  tags_raw:
  - Endpoint
  properties:
  - type: OpenAPI
    url: openapi/aetna-endpoint-api-openapi.yml
  - 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/
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v1/providerdirectory/metadata
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: CapabilityStatement
    url: fhir/aetna-provider-directory-capability-statement.json
- aid: aetna:aetna-location-api
  name: Aetna Location API
  description: The Location API from Aetna — 2 operation(s) for location.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apif1.aetna.com/fhir
  tags:
  - Location
  properties:
  - type: OpenAPI
    url: openapi/aetna-location-api-openapi.yml
  - 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/
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v1/providerdirectory/metadata
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: CapabilityStatement
    url: fhir/aetna-provider-directory-capability-statement.json
- aid: aetna:aetna-organization-api
  name: Aetna Organization API
  description: The Organization API from Aetna — 2 operation(s) for organization.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apif1.aetna.com/fhir
  tags:
  - Organization
  properties:
  - type: OpenAPI
    url: openapi/aetna-organization-api-openapi.yml
  - 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/
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v1/providerdirectory/metadata
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: CapabilityStatement
    url: fhir/aetna-provider-directory-capability-statement.json
- aid: aetna:aetna-organizationaffiliation-api
  name: Aetna Organization Affiliation API
  description: The OrganizationAffiliation API from Aetna — 1 operation(s) for organizationaffiliation.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apif1.aetna.com/fhir
  tags:
  - OrganizationAffiliation
  properties:
  - type: OpenAPI
    url: openapi/aetna-organizationaffiliation-api-openapi.yml
  - 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/
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v1/providerdirectory/metadata
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: CapabilityStatement
    url: fhir/aetna-provider-directory-capability-statement.json
- aid: aetna:aetna-practitioner-api
  name: Aetna Practitioner API
  description: The Practitioner API from Aetna — 2 operation(s) for practitioner.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apif1.aetna.com/fhir
  tags:
  - Practitioner
  properties:
  - type: OpenAPI
    url: openapi/aetna-practitioner-api-openapi.yml
  - 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/
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v1/providerdirectory/metadata
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: CapabilityStatement
    url: fhir/aetna-provider-directory-capability-statement.json
- aid: aetna:aetna-providerdirectorydata-api
  name: Aetna Providerdirectorydata API
  description: The Providerdirectorydata API from Aetna — 11 operation(s) for providerdirectorydata.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apif1.aetna.com/fhir
  tags:
  - Providerdirectorydata
  properties:
  - type: OpenAPI
    url: openapi/aetna-providerdirectorydata-api-openapi.yml
  - 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/
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v1/providerdirectory/metadata
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: CapabilityStatement
    url: fhir/aetna-provider-directory-capability-statement.json
- aid: aetna:aetna-patient-access-api
  name: Aetna Patient Access API
  description: The Patient Access API from Aetna — 83 operation(s) for patient access.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apix.cvshealth.com
  tags:
  - Patient Access
  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://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/
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v1/providerdirectory/metadata
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: CapabilityStatement
    url: fhir/aetna-provider-directory-capability-statement.json
- aid: aetna:aetna-provider-directory-api
  name: Aetna Provider Directory API
  description: The Provider Directory API from Aetna — 9 operation(s) for provider directory.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apix.cvshealth.com
  tags:
  - Provider Directory
  properties:
  - type: OpenAPI
    url: openapi/aetna-provider-directory-api-openapi.yml
  - 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/
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v1/providerdirectory/metadata
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: CapabilityStatement
    url: fhir/aetna-provider-directory-capability-statement.json
- aid: aetna:aetna-healthcare-service-api
  name: Aetna Healthcare Service API
  description: The Healthcare Service API from Aetna — 2 operation(s) for healthcare service.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apix.cvshealth.com
  tags:
  - HealthcareService
  tags_raw:
  - Healthcare Service
  properties:
  - type: OpenAPI
    url: openapi/aetna-healthcare-service-api-openapi.yml
  - 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/
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v1/providerdirectory/metadata
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: CapabilityStatement
    url: fhir/aetna-provider-directory-capability-statement.json
- aid: aetna:aetna-insurance-plan-api
  name: Aetna Insurance Plan API
  description: The Insurance Plan API from Aetna — 1 operation(s) for insurance plan.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apix.cvshealth.com
  tags:
  - InsurancePlan
  tags_raw:
  - Insurance Plan
  properties:
  - type: OpenAPI
    url: openapi/aetna-insurance-plan-api-openapi.yml
  - 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/
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v1/providerdirectory/metadata
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: CapabilityStatement
    url: fhir/aetna-provider-directory-capability-statement.json
- aid: aetna:aetna-practitioner-role-api
  name: Aetna Practitioner Role API
  description: The Practitioner Role API from Aetna — 1 operation(s) for practitioner role.
  humanURL: https://developerportal.aetna.com/
  baseURL: https://apix.cvshealth.com
  tags:
  - PractitionerRole
  tags_raw:
  - Practitioner Role
  properties:
  - type: OpenAPI
    url: openapi/aetna-practitioner-role-api-openapi.yml
  - 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/
  - type: APIReference
    url: https://apif1.aetna.com/fhir/v1/providerdirectory/metadata
  - type: Documentation
    url: https://developerportal.aetna.com/
  - type: CapabilityStatement
    url: fhir/aetna-provider-directory-capability-statement.json
common:
- type: Overlay
  url: overlays/aetna-provider-directory-api-overlay.yaml
- 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:


# --- truncated at 32 KB (32 KB total) ---
# Full source: https://raw.githubusercontent.com/api-evangelist/aetna/refs/heads/main/apis.yml

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