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What has changed on the Aetna Payer Sheet?
The payer sheet has been updated to indicate our preference to accept the NPI Provider Qualifier and ID as well as the Prescriber NPI Qualifier and ID.

How will Aetna be notified of my pharmacy’s NPI?
Aetna receives weekly files from NCPDP which include the pharmacy NPI for those pharmacies who have been assigned an NPI.

You may confirm your NPI number is on file directly with Aetna Pharmacy Management by:
  • Emailing the NPI information to RxNewProvider@aetna.com, or
  • Faxing to 860-273-4876, Attention: Provider Enrollment.
The e-mail or fax should include the 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 Aetna Pharmacy Management’s Provider Help Line for assistance.

How will I know if Aetna has my NPI?
In order to meet HIPAA requirements, Aetna prefers to receive the pharmacy NPI on all electronic claim transactions. Aetna will receive NPI data on the NCPDP Provider file. If a claim is submitted with the NPI and we do not have the NPI on file, the claim will deny. Please recheck your NPI entry to verify a correct number entry.

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” along with a customized message of “NPI not found.” First, verify the correct NPI was entered into the online claims system. If the NPI entered is correct, we encourage you to contact the Provider Help Line at 1-800-238-6279 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.

Will pharmacies be able to submit an NPI as the Prescriber ID?
Aetna will be able to accept claim transactions submitted with the NPI as the Prescriber ID.

Will Aetna require the Prescriber ID to be submitted with the NPI after 5/23/08?
At this time, Aetna will continue to accept either the Prescriber NPI or DEA number after 5/23/08 (or State License number for Texas based pharmacies). However, when available, Aetna prefers the Prescriber NPI.

Will Prescriber Last Name be used/required for additional matching criteria?
No, prescriber last name will not be required.

Aetna Pharmacy Management Provider HelpLine
Available 24 hours day, 7 days a week
1-800-238-6279

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