Tuesday, December 23, 2008

Aetna Health Insurance Electronic Remittance Advice Updates

For all medical offices that bill to Aetna Health Insurance please be aware of their new announcement regarding electronic remittance advice.

Starting March 30, 2009 Aetna will not send Electronic Remittance Advice (ERA's) to providers subject to the National Provider Identifier regulations when

1. A billing provider NPI is not sent on the claim and

2. we have not been notified of a specific override NPI to use on ERA's and

3. the payee does not have a default NPI recorded in Aetna's health insurance providers records

If Aetna Health Insurance does not have a NPI or they adjudicate or reprocess a claim that was submitted without a Billing Provider NPI you will receive the explanation of benefits by paper.

At this time your medical office or billing service maybe submitting medical claims without submitting the NPI number. Right now Aetna health insurance will send your Explanation of Benefits using the Electronic Remittance Advice if it is currently enabled. But on March 30, 2009 those same medical claims will no longer be eligible for electronic remittance advice until you submit the Billing Provider NPI.

If you would like to ask Aetna Health Insurance to continue to receive the payee NPI loaded in to the Aetna Health Insurance system you may send Aetna a email request to their dedicated mailbox aetnanpiera@aetna.com.

Aetna health insurance will be looking for NPI's at the Payee ID source, Group ID source and/or the 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.

If you have access to Aetna Health Insurance's Secure Provider Website you can access the NPI's assigned to your provider if you have registered for the ERA/EFT feature.

Please be aware of these new updates and confirm that you are submitting the NPI numbers now so you will not see a issue with your Explanation of Benefits. Waiting on paper EOB's can become extra work for any billing department when identifying paid/unpaid claims and the status of such.

For those who bill using RelayHealth: Aetna Health Insurance CPID#'s are 4500 and 6400. If you are new to billing or are interested in learning more about medical claims reports please visit: Medical Claims Clearinghouse Reports

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