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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.

agent native

Real signal across most facets with visible, nameable gaps — the contract exists but is thin, or the portal is good while governance and commercial terms are absent.

Kin Score
travel_explore apis.io index code GitHub sourcepublic Website

API Evangelist profiles Aetna the way a machine reads it — 128 machine-readable artifacts across 95 APIs, pulled from the provider's own public surface and indexed so a developer, an analyst, or an AI agent can evaluate it against every other provider on the network.

Every provider in the network is reduced to the same set of machine-readable artifacts — OpenAPI contracts, event specifications, GraphQL schemas, runnable collections, pricing and rate-limit signals, security posture, OAuth scopes, and the agent surfaces (MCP servers and skills) that let software drive the API on its own. We profile them because the interface is the part of a company you can actually inspect: it is a truer signal of what a provider does than any marketing page. From those artifacts we compute the Kin Score — Aetna scores 47.5/100 (developing), with a separate agent-readiness read of 42/100 (agent native). The full breakdown is below, followed by every artifact we hold — each card links through to its machine-readable definition on apis.io.

Kin Score

This is the API Evangelist rating — a single, repeatable read computed from the artifacts on this page. Green fill is points earned; the red track is points possible, so every bar shows earned-versus-possible at a glance. Every facet and dimension name is a link: it opens that measurement's page on APIs.io, where the rating runs across the whole catalog — the exact checks that feed it, how every profiled provider distributes on it, and who is at the top of it.

Kin Score Kin Score How this is scored →
scored 2026-09-10 · rubric v0.20.0
Composite quality — 47.5/100 · developing
Contract Quality 9.6 / 25
Developer Ergonomics 8.5 / 20
Access Clarity 6.6 / 20
Operational Transparency 4.1 / 13
Contract Governance 4.0 / 12
Discoverability 7.4 / 10
Regulatory · Health 10.2 / 15
Agent readiness — 42/100 · agent native
Machine-Readable Contract 18 / 18
Agentic Access Contract derived 2.5 / 10
Documented Reversibility 6 / 6
MCP Server 0 / 12
Machine-Readable Auth negotiable 7.5 / 10
Idempotency 9 / 9
Stable Error Semantics 8.0 / 8
Request/Response Examples 7.0 / 7
Rate-Limit Signaling documented 3.5 / 7
Typed Event Surface 0 / 6
Agent Skills derived 1.3 / 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 documented 3.0 / 6
Protected Resource Metadata 0 / 5
Registration Without a Human 0 / 6
Agentic Commerce Well-Known Document 0 / 5
Aetna Kin Score — API readiness rating by API Evangelist

Put this on your own site. The badge is drawn live from Aetna's current Kin Score — paste it once and it updates itself every time the score is recomputed. It follows your visitor's light or dark setting, and it links back here so anyone who sees it can read the full breakdown.

<!-- Kin Score · API Evangelist -->
<a href="https://providers.apievangelist.com/providers/aetna/"
   title="Aetna on API Evangelist — API profile and Kin Score">
  <img src="https://apis.io/badge/aetna.svg"
       alt="Aetna Kin Score — API readiness rating by API Evangelist" width="150" height="150" loading="lazy">
</a>

More shapes, themes and sizes → · Score as JSON · How badges work

How we profile Aetna

Each block below is one kind of artifact we hold for Aetna. For each we say what it is and why it earns a place in the profile, then list every one we've indexed — capped at two rows, scroll within the panel for the rest.

APIs 7

Each API is captured as its own OpenAPI definition — every operation, parameter, and response. This is the single most useful machine-readable description of what an API does, and it's what lets us score, lint, mock, and generate against it without asking the provider for anything.

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

Where a provider ships GraphQL, the schema is the contract. We profile it alongside the REST surface so the whole interface is legible in one place.

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

Pricing is part of the interface. Machine-readable plans tell you what a tier costs and includes before you commit — one of the things the Kin Score reads for access clarity — renamed from commercial clarity in rubric 0.12, because a free statutory interface has access terms and no commercial ones.

Published pricing tiers and plan structures.

Aetna Plans Pricing

0 plans

PLANS

Rate Limits 1

Rate limits are the difference between a demo that works and a production integration that doesn't fall over. Publishing them is an operational-transparency signal — and a hard requirement for any agent that plans its own throughput.

Documented rate limits and quota policies.

Aetna Rate Limits

0 limits

RATE LIMITS

FinOps 1

Cost, billing, and metering signals let a buyer model the financial operations of an API before it's live. We profile them for the same reason we profile pricing: the money is part of the contract.

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

Aetna Finops

FINOPS

Features 6

The notable capabilities this provider advertises, captured as structured features so they can be searched and compared instead of read one landing page at a time.

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 describe the data models behind the API. We profile them so the shapes are validatable on their own — useful long after a single request is forgotten.

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

Real request and response payloads are what turn a spec from abstract into obvious — and they're one of the twelve things an agent needs to call an API correctly on the first try.

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 — the evidence that a provider takes security seriously enough to document it. We profile it because you can't govern what you can't see.

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 are the vocabulary of least-privilege access. Profiling them shows exactly what an integration — or an agent acting on a user's behalf — is allowed to do.

OAuth scopes governing access to this provider's APIs.

Aetna Scopes

54 scopes · authorizationCode/clientCredentials

54 scopes

SCOPES

Agentic Access 1

An x-agentic-access contract marks which operations are safe for an agent to run on its own and which need a human in the loop. It is the difference between an API an agent can use and one it can use safely.

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

Aetna Agentic Access

99 operations

99 operations · 0 acting

AGENTIC

Use Cases 6

What developers actually build with this provider — captured so the catalogue answers 'what is this for', not just 'what does this expose'.

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 tell you where this provider already fits in a stack.

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.

Resources

Every other property we hold for Aetna — documentation, portals, status pages, policies, and corporate surface — grouped by the job it does, following the integrator's arc from getting started to running in production.

Get Started 6

Portal, sign-up, and the first successful call

Sandbox
Sandbox
 DeveloperPortal
DeveloperPortal
 GettingStarted
GettingStarted
 SignUp
SignUp
 Login
Login
 Portal
Portal

Documentation 29

Reference material describing how the API behaves

OpenAPI
OpenAPI
 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
JSONSchema
 JSONSchema
JSONSchema
 JSONSchema
JSONSchema
 JSONSchema
JSONSchema
 JSONSchema
JSONSchema
 JSONSchema
JSONSchema
 JSONSchema
JSONSchema
 JSONSchema
JSONSchema
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JSONSchema
 JSONSchema
JSONSchema
 JSONSchema
JSONSchema
 JSONSchema
JSONSchema
 JSONSchema
JSONSchema
 Documentation
Documentation
 APIReference
APIReference

Scroll within the panel for all 29 ·

Agent Surfaces 5

MCP servers, agent skills, and machine-readable catalogs

X-MCPServerCandidate
X-MCPServerCandidate
 AgentSkill
AgentSkill
 LLMsTxt
LLMsTxt
 WellKnown
WellKnown
 AgenticAccess
AgenticAccess

Design & Contract 6

Pagination, idempotency, versioning, errors, and events

Vocabulary
Vocabulary
 Conformance
Conformance
 ErrorCatalog
ErrorCatalog
 Conventions
Conventions
 Lifecycle
Lifecycle
 DataModel
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
 Examples
Examples
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Examples
 Examples
Examples
 Examples
Examples
 Examples
Examples
 Examples
Examples
 Examples
Examples
 Examples
Examples
 Examples
Examples
 Examples
Examples
 Packages
Packages
 GitHubOrganization
GitHubOrganization

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Access & Security 4

Authentication, authorization, and security posture

Authentication
Authentication
 OAuthScopes
OAuthScopes
 Compliance
Compliance
 DomainSecurity
DomainSecurity

Operate 6

Status, limits, changes, and where to get help

Deprecation
Deprecation
 ChangeLog
ChangeLog
 ChangeLog
ChangeLog
 Roadmap
Roadmap
 RateLimits
RateLimits
 Support
Support

Commercial 4

Pricing, plans, and the legal terms of use

Plans
Plans
 FinOps
FinOps
 PrivacyPolicy
PrivacyPolicy
 TermsOfService
TermsOfService

Company 2

The organization behind the API

Website
Website
 LinkedIn
LinkedIn

Other 2

Properties that don't map to a standard resource type

Overlay
Overlay
 CapabilityStatement
CapabilityStatement

← All providers · Data indexed from github.com/api-evangelist/aetna · machine-readable index on apis.io

Where this information came from

This is an independent, third-party profile of Aetna, published by API Evangelist. We do not operate, host, resell, or support these APIs, and we are not affiliated with or endorsed by the company unless stated above. Everything here is built from publicly available information — the company's own site, developer portal, documentation, public repositories, and the specifications it publishes for public use. Nothing is obtained by breaching a system, defeating an access control, or using credentials.

The Kin Score and Agent Readiness rating are independently calculated assessments of a company's public API artifacts, scored against a published rubric. They are not certifications, endorsements, security assessments, or audits.

Corrections, re-scores, and removal are free — no partnership or purchase required, and you do not need to justify the request. A removed company is recorded as unrated, never scored zero for having asked. Acknowledgement within one business day; removal within two.

info@apievangelist.com · Read the full data-sourcing policy →
On a security or compliance team? Put security in the subject line and you will get a person, not a form — we will tell you exactly which public URLs this profile was built from.