Common Billing Error - Taxonomy Codes Missing, Incorrect or Inactive

This is a reminder to include taxonomy codes when submitting claims to PHPs, either by individual providers or through a trading partner.

Similar to NCTracks, all PHP systems require taxonomy codes to be submitted on all claim types except pharmacy point of sale claims. When submitting claims to these systems, it is important that providers continue to submit the appropriate billing and, when applicable, rendering/attending taxonomy code which is expected to be consistent with the codes on their NCTracks provider record based on the service rendered and the rendering/attending provider location. Both the billing provider and the rendering provider have 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 PHPs.

The NCTracks How to view and update Taxonomy on the Provider Profile in NCTracks User Guide provides additional information on how to view and update taxonomy on the provider profile.  

Refer to the Managed Care Claims and Prior Authorizations Submission: Frequently Asked Questions – Part 2 fact sheet for additional information on what each PHP requires for claim submission.