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NPI Overview for Medical Professionals

Effective March 16, 2009, to comply with HIPAA regulations, we began rejecting 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.

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:  

  • If you’re a registered user of our secure physician website, you can log in and select "Update Profiles," then "Add/Update National Provider Identifier (NPI)."
  • Use the NPI submission form that allows for submission of up to five NPIs. Fax it to us at 859-455-8650, with subject line "NPI Submission." Or e-mail it to us at AetnaNPI@aetna.com.
  • You can also request a file transfer spreadsheet for larger, more complex physician groups, hospitals, IPAs, and other providers who are sharing multiple NPIs at once. Please be sure to complete all required data fields to help us understand how the NPIs will be used. 

    Remember: Before you can use your NPIs in eligibility, claim status inquiry, precertification or referral transactions, they must be loaded into our system.

There are several ways to provide your NPI to Aetna Dental for our files:

  • Update your Personal Information on aetnadental.com (site registration required).
  • Call our National Dentist Line at 1-800-451-7715.
  • Fax your NPI to us at 860-754-1602.

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.

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