Claims Processing – Use of Taxonomy Codes with Claim Submissions
Correction to Bulletins BT200702, BT200703, and BT200706: For all provider fields, the taxonomy code is only required if needed to obtain a one-to-one match to the provider’s Legacy Provider Identifier (LPI). For claims received with the billing provider NPI only (no taxonomy), and a one-to-one match cannot be obtained from the NPI and service location ZIP Code+4, the IHCP will return the claim to the provider.
First Steps providers must continue to use the appropriate taxonomy codes when submitting claims to ensure their services are reimbursed correctly. In addition, waiver providers submitting claims with an NPI must not bill a taxonomy code on their claim.
This crosswalk links the types of providers and suppliers who are eligible to apply for enrollment in the Medicare program with the
appropriate Healthcare Provider Taxonomy Codes. This crosswalk includes the Medicare Specialty Codes for those provider/supplier
types who have Medicare Specialty Codes. The Healthcare Provider Taxonomy Code Set is available from the Washington
Publishing Company (www.wpc-edi.com) and is maintained by the National Uniform Claim Committee (www.nucc.org). The code
set is updated twice a year, with the updates being effective April 1 and October 1 of each year. This document reflects Healthcare
Provider Taxonomy Codes effective for use on April 1, 2008.
When changes are made to Medicare provider enrollment requirements, the Medicare Specialty Codes, or the Healthcare Provider
Taxonomy Code Set, this document may need to be revised
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The other ID number of the referring provider, ordering provider, or other source should be reported in 17a in the shaded area. The qualifie...
Item 17 Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicia...
For Adjustments: When requesting an adjustment to a paid claim, enter an “A” followed by the 13-character internal control number (ICN) as...
Item 21 - Enter the patient's diagnosis/condition. With the exception of claims submitted by ambulance suppliers (specialty type 59), al...
Bottom section of the CMS 1500 form Supplemental information Shaded line �� In the shaded area across Fields 24A through 24H, enter s...
Billing instruction for Ambulance Billing - Box 20 to 23 BlockNo. Block Name Block Code Notes ...
When submitting attachments with the CMS-1500 claim form, please follow these guidelines: Any attachment should be marked with the benef...
Click the image for see full size sample CMS 1500 claim form. Claim Form Sample
TWO-DIGIT QUALIFIERS The shaded fields in boxes 17a, 24I, 24J, 32b and 33b should be used to report provider numbers other than the NPI as...