Are taxonomy codes required on claims

Are Taxonomy Codes Required on Claims?

What is a taxonomy code?

A taxonomy code is a 10-character code that uniquely identifies your categorization and specialty. When applying for a National Provider Identifier, or NPI, this code will be required.

Individual and organizational providers are assigned taxonomy codes. Taxonomy codes are classified into three levels: provider type (Level I), classification (Level II), and area of specialization (Level III).

You can find a full list of taxonomy codes on the Washington Publishing Company (WPC) website in the Health Insurance Portability and Accountability Act (HIPAA) related code list section, at http://www.wpc- edi.com/products/codelists/alertservice.

Where do I find my taxonomy code?

If you need to lookup a taxonomy code, it’s simple to do so. Follow the steps outlined below to get started: –

  • Visit https://npiregistry.cms.hhs.gov/
  • Enter your NPI Number into the field, and then click Search.
  • Once you click on search you will find your taxonomy number listed on the website.

Taxonomy Codes Required on Professional Claims

Beginning January 1, 2020, taxonomy codes will be required for submitting professional claims for all HAP and HAP Empowered business lines.

It is necessary for accurate and timely claim processing and complies with the National Standardized Billing Standards.

Are taxonomy codes required on claims

How to Submit Taxonomy Codes on Your Claims

Taxonomy codes are placed in segment PRV03 and loop 2000A for the billing stage, and segment PRV03 and loop 2420A for the rendering stage, on electronic claim submissions using the ASC X12N 837P and 837I format.

The taxonomy code should be marked with the qualifier “ZZ” in the darkened portion of box 24i for paper CMS-1500 professional statements.

How can I access the taxonomy code data set?

The Centers for Medicare and Medicaid Services (CMS) has created a taxonomy code crosswalk that connects the categories of providers and suppliers who are eligible to apply for Medicare enrollment to the relevant Healthcare Provider Taxonomy Codes.

View the whole data set at data.cms.gov, where you can download the whole list in a variety of formats.

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