Aetna's logo

Aetna.com. Aetna Dental Home.Aetna Dental FAQs. Email Us

.

.Members and Consumers.|.Employers.|.Producers

.
.
.
.
Aetna Dental Networks
Small BoxInformation About Aetna Dental Networks
Small BoxRequest an Application To Join
Claim Resources
Small BoxDownload Claim Form
Small BoxClaim Documentation Guidelines
Small BoxTips for Submitting Claims and Encounters to Aetna
Small BoxOrthodontic Claim Tips
Small BoxUnderstanding Aetna Oral Surgery Benefits
Small BoxUnderstanding Explanation of Benefits (EOB)
Small BoxPaper Claim Tips
Small BoxGet Paid Directly with AutoDebit
Small BoxSalzmann Evaluation Form
Electronic Services banner
Small BoxAetna Payer IDs
Small BoxInformation About Electronic Services
Small BoxNational Provider Identifier (NPI)
Small BoxElectronic Attachments
Small BoxHelp With Electronic Transactions
Small BoxElectronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT)
Small BoxAetna Voice Advantage (SM)
Educational Resources
Small BoxReminder: Annual Required Medicare Training
Small BoxPractice-Management Coach
Small BoxLinking Dental Care to Overall Health
Small BoxEducational Site for Your Patients
Small BoxPlan for Your Health
(A Site for Your Patients)
Agreement With Dentists
Small BoxOur Commitment to the Dental Community
Other Helpful Tools
Small BoxDocFind® Provider Directory
Small BoxTelephone Numbers and Addresses
Small BoxSpanish for the Dental Office
Aetna Polices yellow bar
Small BoxAppeals Policy
Small BoxDental Clinical Policy Bulletins
Small BoxPreparing for Possible Pandemic
.
.
.
National Provider Identifier (NPI): The One Number You'll Need for All Payers

.
.Key NPI compliance information.
.National Provider Identifier (NPI).
.NPI application process.
.Sharing your NPI with us.
.

Key NPI compliance information

Attention dentists who are submitting claims without NPIs

To comply with HIPAA regulations, we reject electronic claims and encounters submitted without a billing NPI.

Federal regulations require you to submit HIPAA-standard electronic transactions with your NPI number. Additional information on this requirement follows.

Which HIPAA-standard electronic transactions have to include the NPI?

  • Claim
  • Claim Encounter
  • Claim Status Inquiry (CSI)
  • Electronic Remittance Advice (ERA)
  • Interactive Voice Response (IVR)
  • Real-time Eligibility (RTE)

Back To Top

National Provider Identifier (NPI)

HIPAA has mandated the adoption of a National Provider Identifier (NPI), a unique numeric 10-digit identifier assigned to dentists and other health care providers and organizations that are covered entities as defined by HIPAA.

The NPI replaces the many different numbers (Medicare and Medicaid numbers, and other payer proprietary numbers) you currently supply to your payers on electronic claims, certifications and authorization transactions.

An NPI will:

  • Simplify the administration of the health care system and encourage the electronic transmission of health care information.
  • Replace all health plan assigned provider identifiers you previously used (for example, Medicare/Medicaid numbers, etc.).
  • Establish a national standard and unique identifier for you to use with all payers.

An NPI will not:

  • Replace the tax identification number (TIN), which is an IRS requirement.
  • Convey information about you (for example, provider type, service location, etc.).
  • Guarantee reimbursement by dental plans.
  • Enroll you in dental plans.

Back To Top

NPI application process

The Centers for Medicare & Medicaid Services (CMS) has contracted with a vendor to administer the assignment of NPIs and assist health plans and health care providers on issues concerning unique identification.

There are only three ways you can apply for an NPI:

  • Complete the application online at http://www.cms.gov/NationalProvIdentStand/. It takes about 20 minutes to complete the NPI application.
  • Call 1-800-465-3203 to request a paper application.
  • With the provider's permission, an organization may submit the application in an electronic file on behalf of the provider.

Back To Top

Sharing your NPI with us

Please send us your NPI using any one of the following options:
  • Secure website: You can submit your NPI to us through the "Update Personal Info" section of our secure website at www.aetnadental.com. Not registered for our secure website? Go to www.aetnadental.com, and select "Register Now!"
  • National Dentist Line: Call 1-800-451-7715 to submit your NPI to us.
  • Network fax line for participating dentists: Fax your NPI to us at 1-860-754-1602.
  • Submit your NPI information:
    www.aetna.com/info/letstalk/contact_us/npi/npi.html
  • Nonparticipating dentists: Fax your NPI information to: 1-859-455-8650

Learn more from our NPI Frequently Asked Questions.

Back To Top


Copyright 2001-2014 Aetna Inc. .

Web Privacy Statement.Legal Statement.Privacy Notices.Member Disclosure