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Back  RFI # 788: Taxonomy code on 837p

Formal vs. Informal Help Informal Formal

Submitter

Lori Harvey

Description

In the x222 (837p IG), we can require the taxonomy code when it is necessary for adjudication of the claim. In the IG purpose and use information:

1.4.3.2.2.6 Provider Taxonomy Code Reporting
Provider Taxonomy Codes describe provider type, classification, and area of specialization and are maintained by the National Uniform Claims Committee. For use in an 837 claim, the provider determines the code value from the code set (external Code Source 682) that most accurately describes the type and specialty classification under which the provider performed the services reported on the claim. The payer may not dictate the code value to be reported.

it denotes that we cannot dictate the taxonomy code that the provider sends. Does this mean if we have provider contracts that differentiate payment based on the provider acting as a PCP or Specialist, we cannot ask the provider to send in a specific taxonomy code so that we can derive the correct payment schedule?

Thanks!

Response

In the X005010X222 TR3, the Provider Taxonomy Code Situational Rule states: “Required when the payer's adjudication is known to be impacted by the provider taxonomy code. If not required by this implementation guide, do not send.” However, as stated in Section 1.4.3.2.2.6, the payer may not dictate the code value to be reported.” The payer cannot dictate the code value. The Provider must determine and send the Taxonomy Code that most accurately describes the type and specialty classification under which the provider performed the services reported on the claim.
Submission 5/21/2009
Status Date 9/14/2009
Status F - Final
Primary References
Document 005010X222
Section 1.4.3.2
Page2.6
Set ID837p