Health plans have identified a common billing error of providers submitting professional and institutional EDI claims (ASC X12 837-P and ASC X12 837-I) with missing or invalid billing provider, rendering provider and attending provider taxonomy codes.
When billing NC Medicaid Direct claims, providers may have directed clearinghouses to append billing provider, rendering provider, or attending provider taxonomy codes to the claims. This process may not have been established for NC Medicaid Managed Care claims being submitted to the prepaid health plans (PHPs), causing these claims to deny for missing or invalid taxonomies.
Providers should work with their clearinghouses to ensure that the same processes are followed when submitting claims to NC Medicaid Direct and the PHPs.
To facilitate timely adjudication, providers should include the billing provider taxonomy and, when applicable, the rendering provider taxonomy and attending provider taxonomy on claims before sending them to a clearinghouse.
- On professional claims (ASC X12 837-P) the billing provider taxonomy should be included in EDI loop 2000A and the rendering provider taxonomy, when applicable, should be included in EDI loop 2310B.
- On institutional claims (ASC X12 837-I) the billing provider taxonomy should be included in EDI loop 2000A and the attending provider taxonomy, when applicable, should be included in EDI loop 2310A.
For claims that have been submitted to PHPs and denied for invalid billing, rendering, or attending provider taxonomy codes, please immediately resubmit the denied claims using the process outlined above. For assistance, please follow up with the PHP your agency contracts with.
Please refer to the July 9, 2021, Common Billing Error: Taxonomy Codes Missing, Incorrect or Inactive bulletin for additional guidance on submitting valid taxonomy codes.