Aetna Fixes Configuration Error Affecting 55,000 Medicare Advantage Dental Claims

Edited by Dentaltown staff

Aetna has resolved a system configuration error that caused some out-of-network Medicare Advantage dental claims to be adjudicated under Medicare medical rules rather than the rules ordinarily applied to dental benefits, the American Dental Association reported Sept. 3.

Aetna determined during a months-long investigation that about 55,000 claims may have been affected, representing roughly 8% of the out-of-network claims included in the review. Those figures come from information Aetna provided to the ADA.

The insurer told the association it is implementing system changes and that its claims team will adjudicate affected claims correctly while the updates are completed. Aetna also said the team will review previously affected claims to determine whether reprocessing and correction are needed.

The issue surfaced after dentists reported receiving explanations of benefits that appeared to restrict balance billing for out-of-network Medicare Advantage dental services. Aetna initially characterized the individual claim errors as isolated mistakes, but further reports suggested a broader pattern. The ADA then raised concerns with the payer, sought a comprehensive review, and asked how claims were being processed and whether affected claims would be corrected.

Shelley Olson, chair of the ADA Council on Dental Benefit Programs, credited the insurer with acting to identify and correct the error and said the association’s advocacy helped elevate dentists’ concerns.

Liz Papineau, policy chair of the council, said the episode underscores the importance of dentists and their teams remaining “vigilant when reviewing explanations of benefits” and understanding the laws governing dental benefits in their state.

The ADA said it will continue monitoring the issue and advised dentists who believe they were affected to contact Aetna about reprocessing.

Sources:
ADA News, “Aetna resolves Medicare claims-processing error after ADA push,” by Mary Beth Versaci, Sept. 3, 2026: adanews.ada.org/2026/aetna-resolves-medicare-claims-processing-error