Provider Action Needed Impact to You The Centers for Medicare & Medicaid Services (CMS) has released the summary of changes reflected in the Health Care Provider Taxonomy Code (HPTC) list version 8.0. Medicare Fiscal Intermediaries, Carriers, Durable Medical Equipment Regional Carriers (DMERCs) and Regional Home Health Intermediaries (RHHIs) will update their HPTC tables with this new version effective on April 1, 2008.
What You Need to Know The Health Insurance Portability and Accountability Act (HIPAA) requires that submitted data, which is part of a named code set, be valid data from that code set. Claims accepted with invalid data are non-compliant.
What You Need to Do Please review the information included here and stay current on all HIPAA requirements to assure timely processing of your claims.
Background Under HIPAA, code sets that characterizes a general administrative situation, rather than a medical condition or service, are referred to as non-clinical or non-medical code sets. The Provider Taxonomy code set is an external non-medical data code set designed for use in classifying health care providers according to provider type or practitioner specialty in an electronic environment, specifically within the American National Standards Institute (ANSI) Accredited Standards Committee (ASC) health care transaction.
HIPAA requires that submitted data, which is part of a named code set, must be valid data from that code set. The health care provider taxonomy is a named code set in the 837 professional implementation guide, thus carriers must validate the inbound taxonomy codes against their internal HPTC tables.
The HPTCs are updated twice per year, in April and October. The summary of changes for Version 8.0 is noted in the table below:
| TYPE OF CHANGE | PROVIDER TAXONOMY VALUE CODE |
| Additions | 111NP0017X
173C00000X
173F00000X
1835P0018X
253J00000X |
| Revisions | 207ND0101X
207NS0135X
2084A0401X
2086X0206X
2086S0127X |
The HPTC code list is available from the Washington Publishing Company at
www.wpc-edi.com.
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