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
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/downloads/JSMTDL-08515MedicarProviderTypetoHCPTaxonomy.pdf
Instructions and guideline for CMS 1500 claim form and UB 04 form. Tips and updates. Detailed review of all the fields and box in CMS 1500 claim form and UB 04 form and ADA form. HCFA 1500 and UB 92 form instruction.
Pages
- Home
- CMS 1500 claim form - How to fill out correctly - Instruction
- Referring provider, Ordering provider and billing provider - CMS 1500 & UB04 form FAQ
- Medicare provider Enrollment question and answer part 1
- Medicare Enrollment - question and answer part 2
- Complete claim submission - some tips
- Medicare Deductible FAQ
- Secondary claim submission CMS 1500 requirements
- UB 04 - Complete instruction to fill the form
Wednesday, October 6, 2010
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