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

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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. If you received the pharmacy’s store NPI by going directly to CMS or its enumerator, NPPES, your NPI may not be on file with NCPDP. NPPES will not be sharing your NPI with anyone. In order to ensure your NPI number is loaded into the NCPDP database, please download the NCPDP and NPI Pharmacy Application Form at http://www.ncpdp.org/frame_news_npi-info.htm. Fill out the form, attach a copy of your original NPI notification from the enumerator and fax to NCPDP at 480-767-1043.

In addition, the pharmacy may provide the NPI number to Aetna Pharmacy Management directly. To do so, the pharmacy should either:

• e-mail the NPI information to RxNewProvider@aetna.com, or
• fax to 860-273-4876 Attention: Provider Enrollment to provide Aetna with the NPI number.

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 the pharmacy should then contact Aetna Pharmacy Management’s Provider HelpLine for assistance.

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How will I know if Aetna has my NPI?
In December 2006, Aetna began accepting claims submitted with either an NCPDP number or an NPI. Aetna receives NPI data on the NCPDP Provider file on a weekly basis. We also have a crosswalk established to match the submitted NPI with the corresponding NCPDP number. If a claim is submitted with the NPI and we do not have the NPI corresponding to your NCPDP number, the claim will deny. Please recheck your NPI entry to verify a correct number entry.

If the number is not yet on file, please provide the NPI number to Aetna Pharmacy Management directly. To do so, the pharmacy should either e-mail the NPI information to RxNewProvider@aetna.com, or fax to 860-273-4876 Attention: Provider Enrollment to provide Aetna with the NPI number.

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 the pharmacy should then contact Aetna Pharmacy Management’s Provider HelpLine at 800-238-6279 for assistance.

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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 stating: Non-Matched Provider ID along with a customized message of “NPI not found”. First verify the correct NPI was entered into the on-line claims system. If the NPI entered is correct we would then encourage the pharmacy to resubmit the claim with the NCPDP number until the NPI discrepancy is corrected.

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When will Aetna require that claim transactions be submitted with the pharmacy NPI?
Aetna will continue to accept either the Provider NPI or NCPDP number until 5/23/08. However, when available, Aetna prefers the Provider NPI.
Note: This also applies to Universal Claim Form (UCF) Processing.

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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.

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Will Aetna require the Prescriber ID to be submitted with the NPI after 5/23/08?
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.

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

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