Taxonomy Guide

In accordance with SNIP level 4 edits, a valid taxonomy is a requirement for all providers when submitting both paper and electronic claims. This guide will provide basic information to further instruct and educate all providers in assistance with taxonomy submittals. Taxonomy code is constructed of 10 digits- numeric and alpha: (see example 1)

Example: 282N00000X

Electronic:

Billing- Loop 2000A-PRV01 “BI” PRV02 = “ZZ” qualifier PRV03 = 10 character taxonomy 

Rendering- Loop 2310B PRV01 “PE” = Referring PRV02 = “ZZ” qualifier PRV03 = 10 character taxonomy code

Referring- Loop 2310A PRV01 “RF” = Referring PRV02 = “ZZ” qualifier PRV03 = 10 character taxonomy code

Tips:

* Qualifiers are to be included on both paper and electronic claims for proper submission

of claim

* Provider should be billing with the taxonomy that is filled with DCH

*  See the following websites for additional information billing information: www.NUCC.org and www.NUBC.org

Taxonomy guide for CMS 1500 from wellcare insurance

Wellcare -Taxonomy Guide

In accordance with SNIP level 4 edits, a valid taxonomy is a requirement for all providers when submitting both paper and electronic claims. This guide will provide basic information to further instruct and educate all providers in assistance with taxonomy submittals.

Taxonomy code is constructed of 10 digits- numeric and alpha: (see example 1)

Tips:

 Qualifiers are to be included on both paper and electronic claims for proper submission of claims

 Provider should be billing with the taxonomy that is filled with DCH

Wellcare taxonomy code rejection - How to resolve it - paper and electronic claim

Taxonomy Guide

In accordance with SNIP level 4 edits, a valid taxonomy is a requirement for all providers when submitting both paper and electronic claims. This guide will provide basic information to further instruct and educate all providers in assistance with taxonomy submittals. Taxonomy code is constructed of 10 digits- numeric and alpha: (see example 1)

Example: 282N00000X

Provider Taxonomy Codes update

Update to the Healthcare Provider Taxonomy Codes (HPTC) April 1, 2011

Provider Types Affected

Providers who bill carriers including DME MAC.

Provider Action Needed: Impact to You

CMS has released the summary of changes reflected in the Health Care Provider Taxonomy Code (HPTC) list. Medicare carriers and DME MACs will update their HPTC tables with this new version effective on April 1, 2011.

What You Need to Know

The Health Insurance Portability and Accountability Act (HIPAA) requires that submitted data, which is part of a named code set, be valid data from that code set. Claims accepted with invalid data are non-compliant.

What You Need to Do

Please review the information included here and stay current on all HIPAA requirements to assure timely processing of your claims.

Background

Under HIPAA, code sets that characterizes a general administrative situation, rather than a medical condition or service, are referred to as non-clinical or non-medical code sets. 

The provider taxonomy code set is an external non-medical data code set designed for use in classifying health care providers according to provider type or practitioner specialty in an electronic environment, specifically within the American National Standards Institute (ANSI) Accredited Standards Committee (ASC) health care transaction.

HIPAA requires that submitted data, which is part of a named code set, must be valid data from that code set. The health care provider taxonomy is a named code set in the 837 professional implementation guide, thus carriers must validate the inbound taxonomy codes against their internal HPTC tables.

Institutional provider Taxonomy code list

Institutional providers may submit a taxonomy code on claims they submit to Medicare. Medicare does not use the taxonomy code for matching a provider’s NPI to the appropriate legacy identifier. 

Medicare uses other claims data for this purpose. Medicare does not use the taxonomy code for any other claims processing purpose. Payers other than Medicare may have requirements for taxonomy codes. 

Medicare will pass any taxonomy code submitted on a Medicare claim to our trading partners on crossover claims, to allow for the possibility that those payers may use it.

If an institutional provider chooses to submit taxonomy codes, the following table supplies the crosswalk from Medicare’s legacy identifier (the OSCAR number) to the appropriate taxonomy code based on the provider’s facility type:

OSCAR Provider Type      SCAR Coding       Taxonomy Code

Short-term (General and Specialty) Hospitals    0001-0879 *Positions 3-6  282N00000X

Critical Access Hospitals   1300-1399 *       282NC0060X

Long-Term Care Hospitals 2000-2299 *      282E00000X

Hospital Based Renal Dialysis Facilities  2300-2499*     261QE0700X

Independent Renal Dialysis Facilities  2500-2899*               261QE0700X

Rehabilitation Hospitals   3025-3099 *        283X00000X

Children’s Hospitals       3300-3399 *        282NC2000X

Psychiatric Hospitals  4000-4499 *      283Q00000X

Organ Procurement Organization (OPO) P in third Position    335U00000X

Psychiatric Unit M or S in third Position     273R00000X

Rehabilitation Unit R or T in third Position     273Y00000X

Hospital Based Satellite Renal Dialysis Facilities 3500-3699

Type of Bill code 72X + 261QE0700X + different zip code than any renal dialysis facility issued an OSCAR that is located on that hospital’s campus

Swing-Bed Unit   U, W, Y, or Z in third Position

Type of Bill Code X8X (swing bed) with one of the following taxonomy codes to define the type of facility in which the swing bed is located

275N00000X if unit in a short-term hospital (U),

282E00000X if unit in a long-term care hospital (W), 

283X00000X if unit in a rehab facility (Y),

282NC0060X if unit in a critical access hospital (Z)