Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2021 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
Answer: Medicare does not require a taxonomy code to process a claim; however, we will verify that the taxonomy code is valid by comparing it with the latest National Uniform Claim Committee (NUCC) Healthcare Provider Taxonomy Codes (HPTC) code set if it is submitted on the claim. We would include the taxonomy code on any crossover to another insurance company. You may wish to check with your clearinghouse or billing company to ensure they are not stripping the taxonomy number from your claim prior to transmitting to Medicare.
In order for your claim to process with the taxonomy number, it must be in the correct position on your electronic claim. Placement of the taxonomy number depends on if the provider is an option code one or three billing provider.
Option Code 1 (Group Practice, Individual Provider Is an Option Code 4)
Option Code 3 (Provider Is in a Solo Practice)
If the taxonomy is submitted in any other position it will be rejected before it comes into our claims processing system (referred to as a front-end rejection). It is equally important that the taxonomy code billed matches the primary type and specialty on your Medicare enrollment record, as well as the enrollment records of other payers. Failure to do so may result in claim denials.
Resource: Change Request 8211 (PDF, 88 KB) and article "Health Care Provider Taxonomy Codes (HPTC) Information."
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 12/01/2020
We've recently uppgraded our website and it looks you're trying to access an old link. Please select an option below.
Attempt to load this page on new site
Go to Home page
Go to Contact Us page
View a related article: