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Become a participating pharmacy. Request an enrollment packet.
Submit pharmacy claims online
Log in and use your secure pharmacy professionals website
Now, you can quickly complete and submit drug authorization requests online. After you log in, choose the “Drug Auths” menu option from Aetna Plan Central. Or, choose the “Drug Authorizations” option under the Services menu. We’ll still fax the authorization directly to you.
While in your secure pharmacy professionals website, you can also find:
As of April 1, 2012, pharmacy claims must be submitted in the NCPDP D.0 format or they will reject
The National Council for Prescription Drug Programs (NCPDP) maintains requirements regarding the standard way pharmacy claims must be transmitted. Telecommunications Standard Version D.0 is an updated version of the Health Insurance Portability and Accountability Act (HIPAA) standard for pharmacy claims transactions. It is an online, real-time request from the pharmacy to the health plan AND a response from the health plan to the pharmacy.
Covered entities, including pharmacies, are required to conform to HIPAA 5010 standards and upgrade to NCPDP D.0 by April 1, 2012. This will ensure the entity can support current pharmacy service transactions and that claims will not reject.
If you have questions about specific fields included within the Aetna D.0 Payer Sheets listed below, related to your software screens/capabilities, please consult with your chain headquarters (if applicable) or software vendor for assistance.
Pharmacy Communications Regarding D.0 Implementation (targeted to pharmacies, chain HQ and software vendors regarding key transaction requirements/changes for Aetna claims submissions in 2012):
Aetna 2013 Payer Sheets (detailed technical specifications):
Aetna 2012 Payer Sheets (detailed technical specifications):