Claims Denied – Taxonomy Codes Missing, Incorrect, or Inactive
Taxonomy codes must be included when submitting claims to prepaid health plans

Taxonomy codes must be included when submitting claims to prepaid health plans

This is a reminder to providers that taxonomy codes must be included when submitting claims to prepaid health plans (PHPs), whether the claim comes from the individual provider or through a clearinghouse. 

Nearly two months after NC Medicaid Managed Care launch, PHPs continue to see the billing issue of professional and institutional EDI claims (ASC X12 837-P and ASC X12 837-I) with missing or invalid (non-taxonomy values or non-enrolled taxonomy codes) billing provider, rendering provider, and/or attending provider taxonomy codes. 

All PHP systems require taxonomy codes to be submitted on all claim types except pharmacy point of sale claims. Submission of claims with missing or incorrect taxonomy codes will cause the claims to deny and delay provider payments. Both the billing provider and the attending/rendering provider should include their own taxonomy codes on the claim. Refer to the July 9, 2021, Common Billing Error: Taxonomy Codes Missing, Incorrect or Inactive bulletin for additional guidance on submitting valid taxonomy codes.

When submitting claims to PHPs, please continue to submit the appropriate billing provider taxonomy which is expected to be consistent with the taxonomy on your NCTracks provider record and valid for the service rendered. To validate your taxonomy code, please use the NCTracks How to view and update Taxonomy on the Provider Profile in NCTracks User Guide.

When applicable, a rendering/attending taxonomy code should also be submitted and should be valid, based on the service rendered and the rendering/attending provider location.

Clearinghouses may be updating taxonomy information submitted by providers, so it is important that providers work with their clearinghouse to ensure valid taxonomy data is submitted to the PHPs on their claims. If a clearinghouse does not submit a taxonomy or if the taxonomy is incorrect, these errors may increase the provider’s claim denials with the PHPs they submit claims to.  

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 with the corrected data. For additional assistance, please follow up with the PHP with which your agency contracts. The following PHP denial/rejection codes may indicate claims have missing/invalid taxonomy codes: 

 



AmeriHealth Caritas

XD8

Attending not enrolled in Medicaid Program*

XE1

Billing Prov not enrolled in Medicaid Program*

XE5

Rendering Prov not enrolled in Medicaid Program*

EDI/Clearinghouse Rejection

ACK/REJECT INVAL INFO – Payer Assigned Claim Control Number – INVALID PAYER CLAIM CONTROL NUMBER SUBMITTED – BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED – ACK/REJECT MISS INFO – Entity’s specialty/taxonomy code. Usage: This code requires use of an Entity Code

EDI/Clearinghouse Rejection

ACK/REJECT MISS INFO – Entity’s specialty/taxonomy code. Usage: This code requires use of an Entity Code. – BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED

EDI/Clearinghouse Rejection

ACK/REJECT MISS INFO – Entity’s specialty/taxonomy code. Usage: This code requires use of an Entity Code. – BILLING PROVIDER TAXONOMY CODE IS REQUIRED

EDI/Clearinghouse Rejection

BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED – ACK/REJECT MISS INFOR – Entity’s specialty/taxonomy code. Usage: This code requires use of an Entity Code.

EDI/Clearinghouse Rejection

INV: BILLING PROV TAXONOMY CD

EDI/Clearinghouse Rejection

INVALID PAYER CLAIM CONTROL NUMBER SUBMITTED – ACK/REJECT INVAL INFO – Payer Assigned Claim Control Number – ACK/REJECT MISS INFO – Entity’s specialty/taxonomy code. Usage: This code requires use of an Entity Code. – BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED

Carolina Complete Health

EU

BILLING PROV TAXONOMY REQUIRED

United Healthcare

N255

Missing/incomplete/invalid billing provider taxonomy

N288

Missing/incomplete/invalid rendering provider taxonomy

N251

Missing/incomplete/invalid attending provider taxonomy

N289

Missing/incomplete/invalid rendering provider name

Blue Cross Blue Shield

562-127

Billing provider NPI Taxonomy is missing

562-128

Submitted billing provider NPI is not registered with submitted Taxonomy

562-151

Rendering provider NPI Taxonomy is missing

562-152

Submitted rendering provider NPI is not registered with submitted Taxonomy

WellCare

0x285

Billing provider Taxonomy Code is missing.

0x287

Rendering Provider Taxonomy Code is missing.

0x262

No taxonomy information to accompany the submitted NPI for either the Rendering or Bill-To Provider.

0x286

Rendering Provider along with Taxonomy is required when Billing Taxonomy is 193200000X or 193400000X.

0x35e

Attending Provider Taxonomy Code is missing.

808

Taxonomy does not exist for Billing Provider. Please compare the information submitted to the information registered with the state of North Carolina.


810

Taxonomy does not exist for Rendering Provider. Please compare the information submitted to the information registered with information registered with the state of North Carolina.

*PHP may be updating their denial/rejection code description.

Contact

NC Medicaid Contact Center, 888-245-0179

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