Provider Taxonomy Code Use for Claims
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Governs the requirement to register and submit correct provider taxonomy codes (billing and rendering) on professional and institutional claims for Healthfirst lines of business listed, to support accurate claims processing and payment.
Added clarification that Rendering Taxonomy is not required when it is the same as the Billing Taxonomy and included examples of where taxonomy codes must appear on CMS-1500 and UB-04 claim form.
Taxonomy Code Usage and Reimbursement Criteria
Taxonomy code usage and reimbursement criteria
Applicability and general reimbursement conditions
Applicable Codes and Taxonomy Placement
| No specific CPT/HCPCS/ICD codes listed in this policy; section present but not populated. |
Claims Submission Requirements and Consequences
Submit claims with applicable NPI and correct taxonomy; include Rendering Taxonomy when different
Submit all claims using the applicable NPI and the correct correlating billing taxonomy. If the Billing Taxonomy differs from the Rendering Taxonomy, submit both taxonomies; if they are the same, submission of the Rendering Taxonomy is not required. Failure to comply may result in claim denials, rejections, or payment discrepancies and reimbursement remains subject to member eligibility and timely filing rules.
- Billing Taxonomy required on claims; Rendering Taxonomy only required when different from Billing Taxonomy.
- Noncompliant claims may be denied or rejected; providers are responsible for accurate coding.
- Reimbursement is subject to member eligibility, program coverage, medical necessity, and timely filing per provider contract and Provider Manual subsection 17.6.
Registry and Terminology Definitions
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