HealthLink  HIPAA Claims

HealthLink  HIPAA Claims Provider Guides

Identifying the provider “par status” is important for proper administration of Open Access claims. The provider participating status can be obtained in the “Line Pricing/Repricing Information” segment (“HCP”). If a claim has been processed as non-participating, the following elements will be populated:

HIPAA Claims

Provider Taxonomy (Specialty) Codes

The Provider Taxonomy Code (Element PRV03) in Loop 2310B (Rendering Provider) or Loop 2000A (Billing/Pay-To Provider) may be used to distinguish whether or not a provider is performing a primary care or specialist service, at the claim level. This is useful to payors needing to identify whether a particular service is primary care or specialty to assign copayment amounts. HealthLink considers the following taxonomy codes as primary care providers: Family Practice 207Q00000X General Practice 208D00000X Pediatrics 208000000X Obstetrics/Gynecology (as PCP) 207V00000X Internal Medicine (as Primary Care Physician) 207R00000X Geriatrics under Internal Medicine 207RG0300X Geriatrics under Family Practice 207QG0300X.

HIPAA webinar

To learn more about HIPAA Claims mapping and become a certified HIPAA EDI Professional, please visit our course schedule page.

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