How ERA payment when multiple provider under one billing NPI

How Aetna payments and ERAs are grouped

*  Due to HIPAA requirements, Aetna will issue separate ERAs and EFTs for each ‘billing’ or ‘pay-to’ NPI. Providers billing with multiple NPIs will receive separate ERAs and EFTs for each NPI.

o Providers billing with multiple NPIs may want to ask about using an "override" NPI value to be used for
all their ERAs, which will reduce the number of payments generated.

* HMO and traditional claims are never grouped together.

* HMO claim payments will generate a separate ERA and EFT for each ‘pay-to’ HMO provider number.

If you have questions regarding your HMO provider numbers or whether or not they can be rolled up to a group provider number to reduce the number of HMO payments, please contact your Network Representative.

Other situations resulting in multiple ERAs/EFTs

* Separate payments for self-insured plan sponsors vs. fully funded plan sponsors.

* Some states require payments from separate bank accounts for plans they regulate.

* Most Aetna claim payments are grouped by payee and sent on a weekly basis. Payments from Medicare
Advantage and most HMO plans are currently sent daily, separated by rendering provider or facility.

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