Aetna
Aetna, a CVS Health company, offers health insurance, dental, vision, and other plans for individuals, families, employers, health care providers, and insurance agents and brokers. As a major U.S. health insurer, Aetna provides federally mandated FHIR R4 APIs for patient access, provider directory, and drug formulary data under CMS Interoperability and Patient Access Final Rule (CMS-9115-F). Provider connectivity is supported through the Availity portal for EDI transactions.
More than an index entry, but the surface is still mostly links rather than artifacts — the cohort most likely to move a full band from modest, well-targeted work.
API Evangelist profiles Aetna the way a machine reads it — 27 machine-readable artifacts across 4 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 29.1/100 (emerging), with a separate agent-readiness read of 7/100 (human only). 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.
Kin Score
How this is scored →scored 2026-07-27 · rubric v0.5
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 4
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
FHIR R4 compliant Patient Access API providing members secure access to their health data including claims, clinical data, and coverage information. Required under CMS Interoper...
Aetna Provider Directory FHIR API
FHIR R4 compliant Provider Directory API providing standardized access to in-network provider and facility information. Enables third-party applications to search for providers,...
Aetna Drug Formulary FHIR API
FHIR R4 compliant Drug Formulary API providing standardized access to plan formulary data including covered drugs, tiers, cost-sharing requirements, and prior authorization requ...
Aetna Provider EDI API
Electronic Data Interchange connectivity for healthcare providers enabling electronic submission of claims, eligibility verification, claim status inquiries, and remittance advi...
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
Aetna, a CVS Health company, is a major U.S. health insurer offering health insurance, dental, vision, pharmacy, and wellness plans for individuals, families, employers, healthc...
GRAPHQLPricing 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 six things the Kin Score reads for commercial clarity.
Published pricing tiers and plan structures.
Aetna Plans Pricing
PLANSRate 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
RATE LIMITSFinOps 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
FINOPSFeatures 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.
Security Posture 1
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.
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 2
Portal, sign-up, and the first successful call
Build 1
SDKs, sample code, and the tooling you integrate with
Access & Security 1
Authentication, authorization, and security posture
Operate 1
Status, limits, changes, and where to get help
Commercial 2
Pricing, plans, and the legal terms of use
Company 2
The organization behind the API
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