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

What is a taxonomy code?


ANSWER: The Healthcare Provider Taxonomy Codes are a HIPAA standard code set named in the implementation specifications for some standard HIPAA transactions. Originally intended to designate specialty, there has been no validation of these taxonomy codes—providers have been able to choose taxonomy code(s) as they desired. Therefore, KY Medicaid has determined that taxonomy code(s) will be utilized as a second identifier only. A provider’s specialty will be indicated within their file.

Taxonomy codes are administrative codes set for identifying the provider type and area of specialization for health care providers. Each taxonomy code is a unique ten character alphanumeric code that enables providers to identify their specialty at the claim level. Taxonomy codes are assigned at both the individual provider and organizational provider level.

Taxonomy codes have three distinct levels: Level I is the provider type, Level II is Classification, and Level III is the Area of Specialization. A complete list of taxonomy codes can be found within the Health Insurance Portability and Accountability Act (HIPAA) related code list section of the Washington Publishing Company (WPC) web site, at http://www.wpc-edi.com/products/codelists/alertservice. If you do not have internet access, you may contact the WPC at 1-425-562-2245 to find out how to purchase a printed code list.

Taxonomy codes are self-reported, both by registering with the National Plan and Provider Enumeration System (NPPES) and by electronic and paper claims submission. Taxonomy Codes registered with NPPES at the time of NPI application are reflected on the confirmation notice document received from NPPES with the provider’s assigned NPI number. Current taxonomy codes registered, including any subsequent changes, may be obtained on an inquiry basis by visiting the NPI Registry Website at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do.

A provider can have more than one taxonomy code. It is critical to register all applicable taxonomy codes with NPPES and to use the correct taxonomy code to represent the specific specialty when filing claims. This will assist in more accurate and timely processing of claims.


Taxonomy codes are not currently required by Blue Cross and Blue Shield of New Mexico (BCBSNM), but are strongly recommended. Taxonomy codes are required for the Blue Cross Community CentennialSM (Medicaid) product. The taxonomy code selected for a Medicaid claim must agree with the type of specialty used when the provider registered with the State of New Mexico. The BCBSNM system utilizes the taxonomy codes; therefore the absence of these codes can result in incorrect payment. Taxonomy codes on electronic claim submissions with the ASC X12N 837P and 837I format are placed in segment PRV03 and loop 2000A for the billing level and segment PRV03 and loop 2420A for the rendering level. For paper UB04 institutional claims, the taxonomy code should be placed in box 81 and should be submitted with the “B3” qualifier. For paper CMS-1500 professional claims, the taxonomy code should be identified with the qualifier “ZZ” in the shaded portion of box 24i. The taxonomy code should be placed in the shaded portion of box 24j for the rendering level and in box 33b preceded with the “ZZ” qualifier for the billing level.

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


PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

074-Clinical Neuropsychologist 103G00000X
152-Counselor 101Y00000X
155-Counselor, Addiction 101YA0400X
177-Counselor, Licensed Associate
Professional (LAPC) 101YP2500X
190-Counselor, Licensed Professional
Clinical (LPCC) 101YP2500X
194-Counselor, Professional 101YP2500X
403-Marriage & Family Therapist 106H00000X
191-Licensed Independent Clinical Social Worker (LICSW, LCSW) 1041C0700X 050-Psychologist 103T00000X
425-Social Worker (LSW) 104100000X
335-Case Manager/Care Coordinator no taxonomy code required
380-Congregate Care (DD) no taxonomy code required
374-Day Support (DD) no taxonomy code required
373-Extended Services (DD) no taxonomy code required
379-Family Support Services (DD) no taxonomy code required
377-Ind Supp Lvg Arrangement (DD) no taxonomy code required
372-Infant Development (DD) no taxonomy code required
381-Minimally Suprvsd Lvg Arrngmnt (DD) no taxonomy code required
382-Supported Living Arrangement (DD) no taxonomy code required
376-Transitional Comm Living Facility (DD) no taxonomy code required
323-Adult Day Care (QSP) no taxonomy code required
318-Adult Family Foster Care (QSP) no taxonomy code required
146-Attendant Care (QSP) no taxonomy code required
312-Case Management – Assment (QSP) no taxonomy code required
313-Case Management – Other (QSP) no taxonomy code required
309-Chore Labor (QSP) no taxonomy code require
308-Chore – Snow Removal (QSP) no taxonomy code required
153-Chore Emrgncy Rspns Sys Comp (QSP) no taxonomy code required
321-Environmental Modifications (QSP) no taxonomy code required
394-Extended Personal Care (QSP) no taxonomy code required
319-Family Home Care (QSP) no taxonomy code required
112-Family Personal Care (QSP) no taxonomy code required
317-Higher Lvl Case Mgmt – Assmnt (QSP) no taxonomy code required
316-Higher Lvl Case Mgmt – Other (QSP) no taxonomy code required
330-Home Delivered Meals (QSP) no taxonomy code required
180-Homemaker (QSP) no taxonomy code required
310-Installation ERS (QSP) no taxonomy code required
205-Non-Med Transport (Carrier-bus, taxi) (QSP) no taxonomy code required
327-Non-Med Transport (Escort) (QSP) no taxonomy code required
326-Non-Med Transport (local-round trip) (QSP) no taxonomy code required
325-Non-Med Transport (out of town) (QSP) no taxonomy code required
396-Nurse Education Care (QSP) no taxonomy code required
209-Nurse Management (QSP) no taxonomy code required


Billing Taxonomy Does Not Match Prov Type
----------------------

Claim/Service denied because a more specific taxonomy code is required for adjudication. The billing provider taxonomy code that is submitted on the claim needs to be a taxonomy code that DMAS expects to receive based on how the provider is enrolled for the services being submitted. (This may be different from the taxonomy code used when obtaining an NPI.)

1392 N94 Servicing Taxonomy Does Not Match Prov Type
----------------------

Claim/Service denied because a more specific taxonomy code is required for adjudication.

The Rendering (Servicing) provider taxonomy code that is submitted on the claim needs to be a taxonomy code that DMAS expects to receive based on how the provider is enrolled for the services being billed. (This may be different from the taxonomy code used when obtaining the NPI.)

No SRVC Taxonomy Code On The Claim
----------------------
Missing/incomplete/invalid rendering provider taxonomy DMAS requires a Rendering Provider Taxonomy Code on the claim and no taxonomy code was submitted.

No Bill Taxonomy Code On The Claim
----------------------
Missing/incomplete/invalid rendering provider taxonomyDMAS requires a Billing Taxonomy Code on the claim  and no taxonomy code was submitted.

N94 Billing Taxonomy Does Not Match Prov Type
----------------------
Claim/Service denied because a more specific taxonomy code is required for adjudication.

The billing provider taxonomy code that is submitted on the claim needs to be a taxonomy code that DMAS expects to receive based on how the provider is enrolled for the services being submitted. (This may be different from the taxonomy code used when obtaining an NPI.)

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