Effective March 16, 2009, to comply with HIPAA regulations, we began rejecting electronic claims and encounters submitted without a billing provider NPI.
Beginning March 30, 2009, we began generating only ERAs that are NPI compliant (PDF). This means that if you send in paper claims without NPIs, you may not receive an ERA. Instead, you may receive a paper or online Explanation of Benefits (EOB).
Keeping Your NPI with Aetna Current
When you need to add or update your NPI, you can share the changes in the following ways:
There are several ways to provide your NPI to Aetna Dental for our files:
Visit our dedicated site for dentists to learn more.
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.
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