This is a reminder to providers that taxonomy codes must be included when submitting claims to prepaid health plans (PHPs), whether the claim comes from the individual provider or through a clearinghouse.
Nearly two months after NC Medicaid Managed Care launch, PHPs continue to see the billing issue of professional and institutional EDI claims (ASC X12 837-P and ASC X12 837-I) with missing or invalid (non-taxonomy values or non-enrolled taxonomy codes) billing provider, rendering provider, and/or attending provider taxonomy codes.
All PHP systems require taxonomy codes to be submitted on all claim types except pharmacy point of sale claims. Submission of claims with missing or incorrect taxonomy codes will cause the claims to deny and delay provider payments. Both the billing provider and the attending/rendering provider should include their own taxonomy codes on the claim. Refer to the July 9, 2021, Common Billing Error: Taxonomy Codes Missing, Incorrect or Inactive bulletin for additional guidance on submitting valid taxonomy codes.
When submitting claims to PHPs, please continue to submit the appropriate billing provider taxonomy which is expected to be consistent with the taxonomy on your NCTracks provider record and valid for the service rendered. To validate your taxonomy code, please use the NCTracks How to view and update Taxonomy on the Provider Profile in NCTracks User Guide.
When applicable, a rendering/attending taxonomy code should also be submitted and should be valid, based on the service rendered and the rendering/attending provider location.
Clearinghouses may be updating taxonomy information submitted by providers, so it is important that providers work with their clearinghouse to ensure valid taxonomy data is submitted to the PHPs on their claims. If a clearinghouse does not submit a taxonomy or if the taxonomy is incorrect, these errors may increase the provider’s claim denials with the PHPs they submit claims to.
For claims that have been submitted to PHPs and denied for invalid billing, rendering, or attending provider taxonomy codes, please immediately resubmit the denied claims with the corrected data. For additional assistance, please follow up with the PHP with which your agency contracts. The following PHP denial/rejection codes may indicate claims have missing/invalid taxonomy codes:
AmeriHealth Caritas |
|
XD8 |
Attending not enrolled in Medicaid Program* |
XE1 |
Billing Prov not enrolled in Medicaid Program* |
XE5 |
Rendering Prov not enrolled in Medicaid Program* |
EDI/Clearinghouse Rejection |
ACK/REJECT INVAL INFO – Payer Assigned Claim Control Number – INVALID PAYER CLAIM CONTROL NUMBER SUBMITTED – BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED – ACK/REJECT MISS INFO – Entity’s specialty/taxonomy code. Usage: This code requires use of an Entity Code |
EDI/Clearinghouse Rejection |
ACK/REJECT MISS INFO – Entity’s specialty/taxonomy code. Usage: This code requires use of an Entity Code. – BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED |
EDI/Clearinghouse Rejection |
ACK/REJECT MISS INFO – Entity’s specialty/taxonomy code. Usage: This code requires use of an Entity Code. – BILLING PROVIDER TAXONOMY CODE IS REQUIRED |
EDI/Clearinghouse Rejection |
BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED – ACK/REJECT MISS INFOR – Entity’s specialty/taxonomy code. Usage: This code requires use of an Entity Code. |
EDI/Clearinghouse Rejection |
INV: BILLING PROV TAXONOMY CD |
EDI/Clearinghouse Rejection |
INVALID PAYER CLAIM CONTROL NUMBER SUBMITTED – ACK/REJECT INVAL INFO – Payer Assigned Claim Control Number – ACK/REJECT MISS INFO – Entity’s specialty/taxonomy code. Usage: This code requires use of an Entity Code. – BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED |
Carolina Complete Health |
|
EU |
BILLING PROV TAXONOMY REQUIRED |
United Healthcare |
|
N255 |
Missing/incomplete/invalid billing provider taxonomy |
N288 |
Missing/incomplete/invalid rendering provider taxonomy |
N251 |
Missing/incomplete/invalid attending provider taxonomy |
N289 |
Missing/incomplete/invalid rendering provider name |
Blue Cross Blue Shield |
|
562-127 |
Billing provider NPI Taxonomy is missing |
562-128 |
Submitted billing provider NPI is not registered with submitted Taxonomy |
562-151 |
Rendering provider NPI Taxonomy is missing |
562-152 |
Submitted rendering provider NPI is not registered with submitted Taxonomy |
WellCare |
|
0x285 |
Billing provider Taxonomy Code is missing. |
0x287 |
Rendering Provider Taxonomy Code is missing. |
0x262 |
No taxonomy information to accompany the submitted NPI for either the Rendering or Bill-To Provider. |
0x286 |
Rendering Provider along with Taxonomy is required when Billing Taxonomy is 193200000X or 193400000X. |
0x35e |
Attending Provider Taxonomy Code is missing. |
808 |
Taxonomy does not exist for Billing Provider. Please compare the information submitted to the information registered with the state of North Carolina. |
810 |
Taxonomy does not exist for Rendering Provider. Please compare the information submitted to the information registered with information registered with the state of North Carolina. |
*PHP may be updating their denial/rejection code description.
Contact
NC Medicaid Contact Center, 888-245-0179