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Attention providers submitting claims without NPIs
Effective March 16, 2009, to comply with HIPAA regulations, we will reject electronic claims and encounters submitted without a billing provider NPI. If a "pay to" provider is identified on a claim, the NPI for that provider must also be included.

Attention providers who receive Electronic Remittance Advices (ERAs)
Beginning March 30, 2009, we will only generate ERAs that are NPI compliant  (2 pages). 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).

Next steps
We encourage all health care professionals covered by the HIPAA regulations to submit claims and other HIPAA standard electronic transactions with NPIs and to stop using legacy identifiers (PIN, PVN, UPIN) on these transactions as soon as possible. We will continue to work diligently to educate providers and bring them into compliance according to the HIPAA regulations.

If you have not already obtained an NPI and shared it with us please visit:

Get Your NPI

Share Your NPI

Use NPIs on claims. However, NPIs must be loaded into our system before they can be used in eligibility, claim status inquiry, precertification or referral transactions. Aetna individual participating providers and hospitals can confirm that their NPIs are in our system before using them in these transactions by reviewing them in our Provider Referral Directory.

View our help document for guidance on submitting transactions with NPIs for organizations  (3 pages)

How to find other providers' NPIs

The federal government's database of NPIs can be searched at https://nppes.cms.hhs.gov/NPPES/NPIRegistrySearch.do.

Our Provider Referral Directory also includes NPIs that have been shared with us.

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.