Using Your National Provider Identifier in
Aetna Electronic Transactions
Aetna Provider eSolutionsSM
Most providers are currently submitting NPIs on claims.
Many providers are already using NPIs in Aetna
real-time electronic transactions.
REMINDER: Be sure you have already shared your NPI with Aetna so that you can be accurately identified when you use your NPI in Aetna real-time transactions.
All covered providers should plan to use NPIs in electronic transactions as soon as possible, and no later than January 31, 2008. / Aetna is currently processing many electronic transactions using National Provider Identifiers (NPIs).
Most providers are already successfully sending claims with NPIs to Aetna.
Many providers are already using NPIs in Aetna real-time electronic transactions. Reminder: NPIs must be shared with Aetna before using them in Aetna real-time transactions. Additional information on how to share your NPIs with Aetna is available.
If you receive an error message when you transmit your NPI in a real-time transaction, you should confirm that Aetna has received and loaded your NPI into its database. You can confirm that your NPI is in Aetna’s system by logging into the Aetna secure provider website and selecting “Update Profiles.” Then, select the NPI tab. Any NPIs you have submitted to Aetna that have been loaded into Aetna’s database will be on the first screen.
If you have not already begun to use your NPI in electronic transactions, find out the steps you need to take to begin including NPIs in your transactions to ensure a smooth transition.
·  If you use a Web-based solution, refer to that website for information.
·  If you submit electronic transactions using computer software, contact your computer system vendor support area for assistance.
Use NPIs in all Aetna transactions as soon as possible, but no later than January 31, 2008.
This will allow time to address and resolve any problems related to NPI submission prior to the end of the NPI contingency period established by CMS. Beginning May 23, 2008, transactions that do not comply with the HIPAA regulations will be rejected.
The following HIPAA standard electronic transactions require NPI use by providers:
·  Claims and Encounters
·  Real-time transactions
o  Eligibility and Benefits Inquiry
o  Claim Status Inquiry
o  Precertification Add
o  Referral Add
While not required by the regulations, Aetna will also process Precertification and Referral Inquiry transactions with NPIs. In addition, payers must use NPIs in Electronic Remittance Advices (ERAs) by May 23, 2008. (Most Aetna ERAs already use NPIs for provider identification; all will do so by that date.)
Obtaining and using other providers’ NPIs
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.
How to find a provider’s NPI
The federal government’s database of NPIs can be searched at https://nppes.cms.hhs.gov/NPPES/NPIRegistrySearch.do. Aetna’s provider referral directory also includes NPIs that have been shared with Aetna.
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. Effective May 23, 2008, the only type of referring provider ID that can be sent is an NPI. If the referring provider NPI is not known, do not include a referring provider ID on the claim.
Use of Identification Numbers other than NPI in Claims and real-time transactions
Aetna has adopted a contingency plan that allows covered providers to continue to use legacy IDs, such as PIN and PVN, in electronic transactions until May 23, 2008.
However, providers are urged to move to compliance with the regulations by January 31, 2008 to ensure a smooth transition. As of May 23, 2008 transactions that do not comply with the regulations will be rejected.
The regulations generally prohibit the inclusion of provider identifiers other than the NPI, except in certain situations. The use of other IDs is only permitted to identify:
·  An entity or individual as a taxpayer using the Tax Identification Number (TIN), Social Security number or employer identification number. This exception only applies to billing/pay-to providers in claims and payees in electronic remittance advices. An NPI must be used to identify covered health care providers as providers in these situations.
·  Non-covered health care providers. For example, a referring provider who does not conduct any electronic transactions is a non-covered provider who may have chosen not to obtain an NPI.
·  Individuals and entities who are not considered health care providers (also known as atypical providers). Atypical providers are persons or groups whose servicesmay be paid for by health benefit plans but do not directly provide health care. Some common examples include:
o  Personal care workers (for example,. aides providing assistance with daily living)
o  Non-medical living arrangements (for example, assisted living, certified family homes, boarding homes, supervised independent living and community residential facilities)
o  Non-emergency transportation providers (for example, taxi services)
·  Entities that administer health benefits but do not directly provide health care such as:
o  Other health plans
o  Individual Practice Associations (IPAs)
·  Providers acting in a way that is not considered to be a provider role, such as information submitter or receiver, or utilization management organization.
For more information, refer to CMS’ answer to question ID 5816 at http://questions.cms.hhs.gov.
Use of identifiers other than NPI in claims
Tax ID numbers (TINs)
Even after May 23, 2008, claims must continue to include the billing provider’s TIN to identify the billing entity as a taxpayer.
Aetna-assigned ID numbers
Currently, Aetna-assigned provider identification numbers are not usually required on claims. However, providers with multiple contracts with Aetna who have been specifically advised to include the Aetna PVN associated with the contract they expect to be paid under on claims, should continue to send those PVNs (along with NPIs) until mid-February 2008.
Medicare OSCAR numbers
Note: OSCAR numbers, commonly referred to as UPIN or MPN, are six-digit Medicare provider numbers issued to facilities.
Institutional providers that bill Medicare using more than one OSCAR number to identify subparts of their facility are required to submit an NPI, or an NPIandtaxonomy code, on all claims they submit to Medicare.Depending on how the provider chose to enumerate, a taxonomy code may not be necessary to identify a subpart.
Important dates regarding OSCAR numbers
·  Currently, Aetna will accept OSCAR numbers on institutional claims priced according to Medicare rules.
·  Beginning May 23, 2008, Aetna will only accept claims with NPI or NPI and taxonomy code.
·  Beginning May 23, 2008, claims with OSCAR numbers will be rejected.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies.
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