Use of Taxonomy Codes with Claim Submissions

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