How will Aetna be notified of my pharmacy’s NPI?
Aetna receives weekly files from the National Council for Prescription Drug Programs (NCPDP). These files include the NPI for those pharmacies assigned an NPI.
Confirm that your NPI number is on file. Contact Aetna Pharmacy Management (APM) by:
Your e-mail or fax should include your Pharmacy Name, NCPDP and NPI numbers, Address, Phone Number, Fax Number, and any other relevant information regarding the update.
If neither e-mail nor fax is available, contact APM’s Provider Help Line for assistance.
What message will be returned if a claim transaction is denied due to the transmission of a claim with an NPI not on Aetna’s file?
An error message will state: “Non-Matched Provider ID.” A customized message will also appear: “NPI not found.”
First, verify the correct NPI was entered into the online claims system. If the NPI entered is correct, contact APM’s Provider Help Line to ensure we have the NPI in our systems.
Must pharmacies submit claim transactions with the pharmacy NPI?
The compliance date for use of NPI in HIPAA standard transactions was 5/23/08. Pharmacies should use their NPI in the Service Provider ID field on claims transactions.
Note: This requirement also applies to Universal Claim Form (UCF) processing.
Can pharmacies submit an NPI as the Prescriber ID?
Aetna can accept claim transactions submitted with the NPI as the Prescriber ID.
Does Aetna require the Prescriber ID to be submitted with the NPI?
At this time, Aetna will continue to accept either the Prescriber NPI or DEA number (or State License number for Texas-based pharmacies). However, when available, Aetna prefers the Prescriber NPI.
Is the Prescriber Last Name used/required for additional matching criteria?
No. Prescriber last name is not required.
Aetna Pharmacy Management Provider Help Line
Available 24 hours day, 7 days a week