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Back  RFI # 663: Provider Taxonomy and NPI

Formal vs. Informal Help Informal Formal

Submitter

Steve Scholze

Description

We are a large provider group and are being told by one of our payers that a taxonomy code (PRV segment) is required at every provider level including Billing Provider (loop 2000A) when we bill using the Rendering Provider (loop 2310B). Note # 2 on page 79 of the 837p Implementation Guide (004010X098A1) specifically indicates that the PRV segment is not used in loop 2000A “when the Billing or Pay-To Provider is a group and the individual Rendering Provider is in loop2310B”. We realize that the payer’s request/requirement for taxonomy codes in both loops is not compliant with the Implementation Guide but would like a response to that effect.

Response

The requester is correct that the current version of the claim Implementation Guide does not provide for taxonomy code in both locations when the Billing Provider is a group and the individual Rendering Provider is also reported.

CMS has recognized this incompatibility of the Implementation Guide with industry business needs in their response to a question on this issue in FAQ #8585, updated June 30, 2008.

As stated in CMS's response, the restriction on taxonomy codes for both the Billing and Rendering Provider is removed in the 005010 next version
of the Implementation Guide.

Recommendation

Individual implementers and trading partners must decide how to proceed in the interim until the updated version is in place. The developers of the Implementation Guide recommend that CMS's FAQ and the provisions of the next version be taken into account in making that decision.
Submission 6/4/2008
Status Date 8/7/2008
Status F - Final
Primary References
Document 004010X098A1
Section3.1
Page79
Set ID837
Table2
Loop2000A
Segment IDPRV