Taxonomy Codes

Taxonomy Codes: The Importance of Accurate Taxonomy Codes

Taxonomy codes are administrative codes set for identifying the practitioner type and area of specialization for health care practitioners. Each taxonomy code is a unique ten character alphanumeric code that enables practitioners to identify their specialty at the claim level. Taxonomy codes are assigned at both the individual practitioner and organizational practitioner level.

Codes have three distinct levels: Level I is the practitioner type, Level II is Classification, and Level III is the Area of Specialization. A complete list of codes can be found within the Health Insurance Portability and Accountability Act (HIPAA).

Codes are self-reported, both by registering with the National Plan and Provider Enumeration System(NPPES) and by electronic and paper claims submission. Taxonomy Codes registered with NPPES at the time of NPI application are reflected on the confirmation notice document received from NPPES with the provider’s assigned NPI number. Current codes registered, including any subsequent changes, may be obtained on an inquiry basis by visiting the NPI Registry website.

A practitioner can have more than one taxonomy code, due to training, board certifications etc. It is critical to register all applicable taxonomy codes with NPPES and to use the correct taxonomy code to represent the specific specialty when filing claims. This will assist EmblemHealth in more accurate and timely processing of claims.

Vendors should provide Taxonomy codes on all EmblemHealth claims, the absence of these codes may result in incorrect payment.

Taxonomy codes on electronic claim submissions with the ASC X12N 837P and 837I format are placed in segment PRV03 and loop 2000A for the billing level and segment PRV03 and loop 2420A for the rendering level. For paper CMS-1500 professional claims, the taxonomy code should be identified with the qualifier “ZZ” in the shaded portion of box 24i. The taxonomy code should be placed in the shaded portion of box 24j for the rendering level and in box 33b preceded with the “ZZ” qualifier for the billing level.

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