Aetna Provider eSolutions Communication

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Gavin Walker
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Aetna Provider eSolutions Communication

Post by Gavin Walker » Tue Dec 16, 2008 5:41 pm

Aetna has asked us to share the following message:

Purpose:
To provide you with information regarding use of NPI in Aetna electronic transactions.

Overview:
For your information, please review the following:

ERA changes effective March 30, 2009
Aetna will not send Electronic Remittance Advices (ERAs) to providers subject to the National Provider Identifier regulations when
  • · a billing provider’s NPI is not sent on the claim and
    · we have not been notified of a specific “override NPI” to use on ERAs and
    · the payee does not have a “default NPI” recorded in our provider records

You will receive only a paper/online Explanation of Benefits (EOB) if:
  • · we adjudicate or reprocess a claim sent without a billing provider NPI and
    · we do not have an NPI on file
If you are currently receiving some ERAs without NPIs, please be sure to:
include the billing provider’s NPI in all your claims (including any paper claims) and
designate an override NPI to be returned on all your ERAs or
designate a default NPI to be used when an NPI is not on the claim


Designating a specific NPI
When a provider chooses to supply Aetna with an NPI value to override the value submitted on the claim, this ensures that:
  • no ERAs are dropped to paper because of missing NPI information and
    the smallest number of payments are sent
When a provider chooses to supply us with a default NPI value, this ensures that:
  • · no ERAs are dropped to paper because of missing NPI information but
    · Aetna will use NPI values when available from submitted claims
How to notify Aetna of an override or default NPI value
You can submit your request to continue to receive the payee NPI loaded into Aetna’s system by sending an email request to our dedicated mailbox [email protected]

Valuing NPIs and TIN in Aetna ERAs
Unless an override or default NPI value is being used, Aetna will value the ERA with NPI values from the claim:
  • Payee ID Source
    Group ID Source
    Rendering Provider ID Source


The TIN and provider business group (PBG) will always be sent to identify the taxpayer ID that will be used for IRS reporting and the provider business area handling remittances for the claim.

How providers can determine which NPIs are included in their ERAs
The payee and rendering provider NPIs are displayed on the Aetna ERA Inquiry page. This page is available to registered users of Aetna’s secure provider website who have signed up for ERA/EFT.

Questions?
Please direct any general questions to your respective Aetna Vendor Account Manager or Aetna Liaison.
Gavin Walker
Walker Tek Solutions, LLC
417-890-6777 x0
fax: 417-763-6386

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