National Provider Identifier (NPI)

We encourage all health care professionals covered by the HIPAA regulations to: 

• Submit claims and other HIPAA standard electronic transactions with NPIs
• Stop using legacy identifiers (PIN, PVN, UPIN) on these transactions as soon as possible
• Obtain, share and use their NPI, regardless of their participation status or transaction submission method.

We will continue to work diligently to educate providers and bring them into compliance according to the HIPAA regulations.

Get your NPI
Individual health care professionals (physicians, dentists and pharmacists) and organizational providers (hospitals, pharmacies, group practices, laboratories, ambulatory care facilities and nursing homes) can apply for an NPI in one of three ways:

• Complete the application online.
• Call 1-800-465-3203 to request a paper application.
• With the provider's permission, an organization may submit the application in an electronic file on behalf of the provider. 

Share your NPI with us
NPIs must be loaded into our system before they can be used in eligibility, claim status inquiry, precertification or referral transactions. There are several ways to submit your NPIs:

• Use the NPI submission form that allows for submission of up to five NPIs. Fax it to us at 859-455-8650, with subject line "NPI Submission." Or e-mail it to us at AetnaNPI@aetna.com.
• If you’re a registered user of our secure physician website, you can log in and select "Update Profiles," then "Add/Update National Provider Identifier (NPI)."
• You can also request a file transfer spreadsheet for larger, more complex physician groups, hospitals, IPAs, and other providers who are sharing multiple NPIs at once. Please be sure to complete all required data fields to help us understand how the NPIs will be used. 

There are several ways to provide your NPI to Aetna Dental for our files:

• Update your Personal Information on aetnadental.com (site registration required).
• Call our National Dentist Line at 1-800-451-7715.
• Fax your NPI to us at 860-754-1602.

Visit our dedicated site for dentists to learn more. 

Find other providers'  NPIs
Search for other providers' NPIs through:

• Federal government database of NPIs 
• Our provider referral directory  

In addition to their own NPIs, many health care providers will need to know and use the NPIs of other providers to submit transactions electronically. Therefore, you should share your NPI with other providers who may require it to conduct electronic transactions.

For example:

• Primary care providers will need to know and use the NPIs of specialists they refer to in referral transactions.
• Specialists will need to know and use the NPIs of facilities associated with care that requires precertification.
• Hospitals will need to know and use the NPIs of admitting and attending physicians in claims.

For professional claims, if there is a referring provider, that provider should be identified by name. The named provider's ID must also be sent, if known. If the referring provider NPI is not known, do not include a referring provider ID on the claim.

Claims must continue to include the billing provider's tax ID number to identify the billing entity as a taxpayer.

Non-covered entities
If you are not a health care provider as defined under HIPAA and the regulations do not apply to you, your transactions will still be processed with legacy identifiers if you submit our NPI Exemption Notification Form. 

Using your National Provider Identifier (NPI) in HIPAA standard electronic transactions
Federal regulations require you to submit HIPAA standard electronic transactions with only your NPI number. For more information see our FAQs.

Pharmacies must also submit claims with an NPI. For more information see our FAQs.