Medical Billing concept – Taxonomy Code

Taxonomy Codes – What are they & how are they used?

The health care provider taxonomy code set is a comprehensive listing of unique 10-character alphanumeric codes. The code set is structured into three levels—provider type, classification, and area of specialization—to enable individual, group, or institutional providers to clearly identify their specialty category or categories in HIPAA transactions. The entire code set can be found on the Washington Publishing Company (WPC) Web site, at http://www.wpc-edi.com/codes/taxonomy. The health care provider taxonomy code set levels are organized to allow for drilling down to a provider’s most specific level of specialization. Listed below is a random sampling of taxonomy codes:

Allergy Immunology 207K00000X

Durable Medical Equipment 332B00000X

Family Practice 207Q00000X

Opthamology 207W00000X

Urgent Care 261QU0200X

Why do I need to know my taxonomy code(s)?

Taxonomy codes further identify you or the practice you are a part of on claims. They can play a critical role in the claims payment process. Electronic claims transactions already accommodate the entry of taxonomy codes. In the near future, paper claims submitters also may be asked to include taxonomy codes on claims.

How Do I Bill for Locum Tenens? 

Within the busy provider world, locum tenens, or substitute physician(s) usually assume professional practices in the absence of a regular physician for reasons such as illness, pregnancy, vacation, continuing education or even filling in while permanent providers are recruited. Coverage ranges from rural solo physician practices to the country’s major health systems and managed care organizations. Locum tenens work is designed to fill these vacancies on an interim basis, although assignments can vary in length from a few days to many months. The solo physician, system or organization generally pays the locum tenens directly as an independent contractor rather than an employee.

As covered health care providers, locum tenens are eligible to obtain NPIs. However the interim, substitute physician may or may not be a contracted BCBSTX provider. Therefore, BCBSTX may not have record of their NPI, and claims received from the locum tenenwould be rejected once submitted for processing.

In these situations, the contracted BCBSTX provider should submit the claims using his or her provider IDs with the Q6 modifier (services furnished by a locum tenens physician). The Q6 modifier should be populated in one of the four modifier areas in field 24D of the CMS-1500 (08/05) form. 

Am I Good to Go?

BCBSTX receives multiple inquiries via our NPI e-mail helpline. Recently, some of you have asked this: “I submit paper and electronic claims. Since paper submitters were approved to begin submitting NPI-only claims as of Dec. 1, 2007, am I OKto submit NPI-only electronic claims as well, or do I still need to wait for a “Congratulations” postcard?” 

There are differences in the processing procedures of electronic claims and paper claims. While BCBSTX announced that paper submitters could begin submitting NPI-only claims as of Dec. 1, 2007, as long as they had submitted their NPI to BCBSTX, electronic claims are not automatically included in that approval. Even if you are a provider who submits both types of claims, please wait to receive your “Congratulations” postcard from BCBSTX before submitting NPI-only electronic claims.

Remember, once you receive the “Congratulations” postcard, contact your electronic trading partners (billing services, clearinghouses and software vendors) to ensure they are aware of your NPI-only status with BCBSTX. If your vendor who submits electronic claims on your behalf has any questions, they may contact our E-Commerce Center at 1-800-746-4614. 

Which Have You Received?

NPI Postcard Clarification New UB-04 “How to Complete” Guide available NOW

During the NPI transition, both contracted and non-contracted providers have diligently participated in submitting their NPI(s) to BCBSTX. To facilitate ongoing communications, BCBSTX currently is mailing two postcards to providers who have either shared information with us or have successfully participated in submitting dual-identifiers on their electronic claims. Here are explanations of the postcards to help clarify any confusion on why they are being recieved.

We are continuing to enhance our educational tools to make it easier for you to serve our members. Please refer to the new guide for completing the UB-04 claim form in the Provider Library of our Web site at www.bcbstx.com. This guide provides you with a sample claim form, including fields designated by BCBSTX as TDI-required, conditional or BCBSTX/HMO Blue Texas requested element. The guide also provides detailed instructions on how to properly complete the form.

Professional Claims Announcement from CMS

The Centers for Medicare and Medicaid Services (CMS) recently announced on their Web site that beginning March 1, 2008, all professional claims must be submitted to Medicare with an NPI in the primary fields on the claim (i.e., the billing, pay-to and rendering fields). Therefore, on a Medicare Fee-For-Service 837P and CMS-1500 (08/05) form, the use of NPI-only or NPI/BCBSTX provider number combinations on submitted claims is allowed. Any Medicare claim submitted without an NPI after this date will be rejected. For more information, please visit the CMS Web site at www.cms.hhs.gov/nationalproviderstand.