On April 1, 2017, Horizon NJ Health will require all practitioners to include their NPI numbers, as well their taxonomy codes, on all claim submissions. This is necessary to ensure our systems properly identify and reimburse your practice appropriately. Nonparticipating practitioners and facilities are also required to adhere to the NPI requirements. After April 1, 2017, claims without a valid NPI and taxonomy code will be rejected/denied for inappropriate billing.
Use of Taxonomy Codes:
Taxonomy codes are administrative codes set for identifying the provider type and area of specialization for health care providers. Each taxonomy code is a unique ten-character alphanumeric code that enables providers to identify their specialty at the claim level.
Taxonomy codes are assigned at both the individual provider and organizational provider level. Taxonomy codes have three distinct levels: Level I is Provider Type, Level II is Classification, and Level III is the Area of Specialization. Examples and discussion of taxonomy codes can be found at;
Submitting Claims with Taxonomy Codes:
For paper UB04 institutional claims, the taxonomy code should be placed in box 81 and should be submitted with the “B3” qualifier.
UB-04 Paper Institutional Claim Form (for enumerated providers)
For paper CMS-1500 professional claims, the taxonomy code should be identified with the qualifier “ZZ” in the shaded portion of box 24i. The taxonomy code should be placed in the shaded portion of box 24j for the rendering level and in box 33b preceded with the “ZZ” qualifier for the billing level.
CMS 1500 (02/12) Professional Claim Form (for enumerated providers)
Please be sure that your claim software supports the revised 1500 claim form (02/12). Reference the 1500 Reference Instruction Service Facility Location NPI Field 32a. You can reference the 1500 Reference Instruction Manual at nucc.org for specific details on completing this form. Additional claim submission guidance is available in Section 9 of the Physician and Health Care Professional Manual.
Taxonomy codes on electronic claim submissions with the ASC X12N 837P and 837I format are placed in segment PRV03 and loop 2000A for the billing level and segment PRV03 and loop 2420A for the rendering level.
If you have any questions, please call the Physician & Health Care Hotline at 1-800-682-9091.