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