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.
Kin Score
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
PLANSRate Limits 1
Documented rate limits and quota policies.
Aetna Rate Limits
RATE LIMITSFinOps 1
Cost, billing, and metering signals for API financial operations.
Aetna Finops
FINOPSFeatures 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
JSON SCHEMAAetna FHIR R4 Bundle
JSON SCHEMAAetna FHIR R4 CarePlan
JSON SCHEMAAetna FHIR R4 CareTeam
JSON SCHEMAAetna FHIR R4 Condition
JSON SCHEMAAetna FHIR R4 Device
JSON SCHEMAAetna FHIR R4 DiagnosticReport
JSON SCHEMAAetna FHIR R4 DocumentReference
JSON SCHEMAAetna FHIR R4 Encounter
JSON SCHEMAAetna FHIR R4 ExplanationOfBenefit
JSON SCHEMAAetna FHIR R4 Goal
JSON SCHEMAAetna FHIR R4 HealthcareService
JSON SCHEMAAetna FHIR R4 Immunization
JSON SCHEMAAetna FHIR R4 InsurancePlan
JSON SCHEMAAetna FHIR R4 Location
JSON SCHEMAAetna FHIR R4 MedicationKnowledge
JSON SCHEMAAetna FHIR R4 MedicationRequest
JSON SCHEMAAetna FHIR R4 Observation
JSON SCHEMAAetna FHIR R4 OperationOutcome
JSON SCHEMAAetna FHIR R4 Organization
JSON SCHEMAAetna FHIR R4 OrganizationAffiliation
JSON SCHEMAAetna FHIR R4 Patient
JSON SCHEMAAetna FHIR R4 Practitioner
JSON SCHEMAAetna FHIR R4 PractitionerRole
JSON SCHEMAAetna FHIR R4 Procedure
JSON SCHEMAScroll 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.
Scopes 1
OAuth scopes governing access to this provider's APIs.
Agentic Access 1
Recommended x-agentic-access execution contracts for AI agents.
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
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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)
Work with this as data
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