Claims submitted with missing or invalid billing, rendering, and/or attending provider taxonomy codes was the number one reason for claim denials shortly after NC Medicaid Managed Care launch.
To avoid this billing issue and ensure claims are timely paid, providers should include taxonomy codes when submitting claims to the Tailored Plans, whether the claim comes from the individual provider or through a clearinghouse.
- All Tailored Plan 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.
Providers should verify that the submitted provider taxonomy code on the claim matches one of the active taxonomy codes listed on the NCTracks provider record and is appropriate for the claim being billed. Providers should validate the configuration of their own billing systems to ensure taxonomies are included when submitting claims to the Tailored Plans.
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.
It is important that providers work with their clearinghouse to ensure new payers are set up correctly for taxonomy and that valid taxonomy data is submitted to the Tailored Plans on their claims. If a clearinghouse does not submit a taxonomy or if the taxonomy is incorrect, these errors may result in claim denials with the Tailored Plans they submit claims to.
Contact
NCTracks Call Center: 800-688-6696