ProviderOne
Taxonomy
Frequently Asked Questions (FAQs)
Last Updated 11/5/09
Changing/Adding/Deleting a Taxonomy
Q: Why does DSHS require taxonomy on claims?
A: Historically, providers have billed DSHS using several Medicaid provider numbers – one for each line of business. However, with the federally mandated use of National Provider Identifiers (NPI), we cannot be certain that providers will continue to have one NPI for each line of business. We are aware that several providers have fewer NPIs than legacy provider numbers. Therefore, ProviderOne will use federal taxonomy (instead of the former Medicaid provider number) to differentiate a providers’ line of business for which they are billing.
For example, today a hospital might have five (5) separate Medicaid provider numbers – one for Durable Medical Equipment (DME), one for hospice services, one for inpatient services, one for laboratory services, and one for radiology services. Over time, providers learned to use their DME provider number for a DME service, their hospice provider number for a hospice service, etc., when billing DSHS. Behind the scenes, these different provider numbers mapped to a DSHS-assigned provider type and specialty (equivalent to a state-defined “taxonomy.”) During claims processing, the current Medicaid payment system validates that the provider’s type and specialty is appropriate for the service billed.
The model is the same with ProviderOne billing, except instead of knowing which Medicaid provider number to use for billing (where each Medicaid provider number is mapped to a line of business); providers need to know which federal taxonomy to use. Like the former Medicaid provider number, the federal taxonomy code is equivalent to a line of business for which the provider is billing.
For example, consider the following scenario for a hospital that have five (5) lines of business and previously had five (5) Medicaid provider numbers, but now only have three (3) NPIs:
|
Medicaid ID |
Type/Specialty |
NPI |
Federal Taxonomy |
|
9xxxxxx |
DME |
XXXXXXX1 |
XX-XX-XXXXX |
|
399xxxx |
Hospice |
XXXXXXX2 |
XX-XX-XXXXX |
|
3xxxxxx |
Inpatient |
XXXXXXX2 |
XX-XX-XXXXX |
|
7xxxxxx |
Laboratory |
XXXXXXX3 |
XX-XX-XXXXX |
|
7xxxxxx |
Radiology |
XXXXXXX3 |
XX-XX-XXXXX |
Because NPI is not necessarily unique to the line of business, DSHS requires another way to validate billed services for a provider. In lieu of using unique Medicaid provider numbers as providers do today, with ProviderOne providers need to bill using the appropriate federal taxonomy. So in the above example, the provider would use the radiology taxonomy for radiology services and the laboratory taxonomy for laboratory services.
Q: Why didn’t DSHS convert the existing provider type and specialty and load in ProviderOne?
A: DSHS converted the existing provider type and specialty information from the current Medicaid payment system into the new nationally recognized, HIPAA-compliant taxonomy codes in ProviderOne. When a provider obtained fewer NPIs than current Medicaid provider numbers, DSHS consolidated the resulting taxonomies under a single NPI. Registration is the process providers need to complete to ensure that the selections DSHS made during the data conversion process are correct.
Q: Why are only some federal taxonomy codes available in ProviderOne?
A: With thousands of taxonomy codes defined at the national level, DSHS selected only the taxonomy codes applicable to DSHS covered services. Therefore, only a sub-set of national codes are recognized as valid taxonomy codes for DSHS covered services and payment.
Q: How often will DSHS update its list of adopted taxonomy codes?
A: DSHS considers taxonomy updates from the National Uniform Claims Committee (NUCC) twice a year (in January and July). DSHS will adopt NUCC updates if the update is applicable to DSHS-covered services. To date, none of the NUCC changes have been relevant to DSHS-covered services.
Q: Can DSHS post a list of taxonomy codes mapped to allowed procedure codes?
A: Unfortunately, publishing such a list is not feasible at this time. Consider that there are thousands of service codes and thousands of taxonomy codes making a published list impractical. For example, DME taxonomy aligns with DME services, inpatient taxonomy aligns with inpatient services, etc.
Q: Will ProviderOne claim processing look at the group taxonomy, the performing provider’s taxonomy, and/or referring provider’s taxonomy?
A: DSHS requires taxonomy for the billing provider AND servicing provider, if the claim includes a servicing provider. Taxonomy is NOT required for the referring provider.
Q: What level of taxonomy specificity does DSHS require for claim processing (general category taxonomy or subspecialty taxonomy)?
A: ProviderOne claim processing is specific to the 10-character taxonomy. If you have a general and specialty taxonomy assigned, you should choose the one that is most descriptive of the service.
Q: The State did not load all of the HIPAA-compliant standard taxonomy codes in their new system. Taxonomy is required in the new system. If, therefore, a provider used a taxonomy code when creating their NPI that DSHS isn’t building into the system, the claim will error. We asked a pointed question during a call: “are you telling providers how to enumerate their taxonomy codes?” and were told no, but it was suggested that maybe a provider would want to reassign their taxonomy to match what is needed by the payer of last resort…? You also had no plan for how to resolve crossover claim issues regarding taxonomy code differences.
A: The national provider taxonomy codes identify a provider’s type and area of specialization. DSHS used a subset of the national provider taxonomy codes – those that are applicable to the services DSHS pays for. Only those taxonomies shown in the drop-down list (Step 3 in Registration) in ProviderOne are being used. There are literally thousands of national taxonomies that DSHS will not be using. DSHS has no way of knowing which taxonomies you used when you registered your NPI at the national level – there is no national database for accessing taxonomies from the Centers for Medicare and Medicaid Services (CMS). Therefore, DSHS assigned taxonomies based on how we know each provider today. When completing the data conversion process to transfer the current provider database into ProviderOne, DSHS mapped each of the current proprietary classifications (provider type and specialty) to an equivalent national provider taxonomy. We wanted to ensure you can bill us for at least the services you bill us for today at go-live. Most taxonomy codes include a broad range of services. There are some taxonomy codes, however, with quite limited approved services (e.g., ventilation/tracheotomy, alcohol and substance abuse, Maternity Support, and Federally Qualified Health Clinics [FQHC]/Rural Health Clinics [RHC]). You may need to refer to your contract (if applicable) or Billing Instructions for your unique program.
Q: How do providers know which taxonomy to use when billing ProviderOne?
A: When deciding which taxonomy to bill in ProviderOne, providers should consider the line of business they are billing for, and then select the taxonomy that best describes that line of business and service rendered. Descriptions of federal taxonomy codes can be found at http://www.wpc-edi.com/taxonomy.
Additionally, providers should be careful and only bill using a taxonomy code that is associated with their file in ProviderOne and as validated during the registration process. During claim processing, ProviderOne validates that the taxonomy is associated with the provider and that the service is allowed by the taxonomy.
Like the old system of using the appropriate Medicaid provider number that aligns with the service, providers will soon become familiar with using the appropriate taxonomy that aligns with the service.
Q: How do providers verify their taxonomies in ProviderOne?
A: DSHS –assigned taxonomies to each provider NPI based on how the provider was configured in the current Medicaid payment system. That is, state-defined type and specialty were mapped to equivalent federal taxonomy codes with the resulting federal taxonomies assigned to the provider’s new NPI. Registration is the process of validating all of a provider’s converted information, including g state-assigned taxonomy. Additionally, DSHS is in the process of developing a Web tool that will allow providers to download a list of taxonomies assigned to them by DSHS. More information about the availability of the Web tool will be communicated via the listserv (the ProviderOne e-mail distribution list).
Q: How do providers view descriptions for federal taxonomy codes?
A: Descriptions for each federal taxonomy code are administered at the federal level by Health and Human Services (HHS). A complete list and descriptions may be found at http://www.wpc-edi.com/taxonomy.
Q: What should providers do if the national taxonomy they selected is not on the DSHS selected list?
A: Unfortunately, providers in this situation will need to change their systems in the short-term to support processing of Medicaid claims in ProviderOne starting December 6, 2009. DSHS has no automated way of knowing which taxonomies providers used then obtaining NPIs at the national level – there is no national database for accessing taxonomies from the Centers for Medicare and Medicaid Services (CMS). Therefore, DSHS assigned taxonomies based on how the state knows each provider today. Additionally, it is a significant system change to ProviderOne to add taxonomies, as it would require changes to ProviderOne software programming. However, DSHS will consider adding requested taxonomies twice a year – each January and July, starting in July 2010. This is the same frequency that taxonomy codes are updated by the National Uniform Claims Committee (NUCC). In the meantime, during registration, please validate the DSHS-assigned taxonomy (or select a taxonomy code from the DSHS-approved taxonomy list) and use that taxonomy when billing.
Changing/Adding/Deleting a Taxonomy
Q: What should providers do if their billing software is pre-programmed with a taxonomy code that is not on the DSHS-selected list?
A: Unfortunately, providers in this situation will need to change their systems in the short-term to support processing of Medicaid claims starting December 6, 2009. DSHS has no automated way of knowing which taxonomies providers used when obtaining NPIs at the national level – there is no national database for accessing taxonomies from the Centers for Medicare and Medicaid Service (CMS). Therefore, DSHS assigned taxonomies based on how the state knows each provider today. Additionally, it is a significant system change to ProviderOne to add taxonomies as it would require changes to ProviderOne software programming. However, DSHS will consider adding requested taxonomies twice a year – each January and July, starting in July 2010. This is the same frequency that taxonomy codes are updated by the National Uniform Claims Committee (NUCC). In the meantime, during registration please validate the DSHS-assigned taxonomy code (or select a taxonomy code from the DSHS-approved taxonomy list) and use that taxonomy when billing.
Q: Can providers request the addition of federal taxonomy codes to ProviderOne?
A: Yes, providers can request DSHS to add a federal taxonomy code. Such changes will be considered in conjunction with federal changes made twice a year (in January and July) by the National Uniform Claims Committee (NUCC). The first time provider-requested changes will be considered is in July 2010.
Q: Will DSHS require taxonomy of Medicare crossovers and TPL claims?
A: Yes, DSHS requires taxonomy on all claims, including Medicare crossovers. Providers must include taxonomy on claims submitted to Medicare when the DSHS client is eligible for Medicaid as a secondary payer. Medicare will verify that the taxonomy is from the valid national code set, then pass the claim on to DSHS. DSHS will process the claims validating that the service is allowed by the taxonomy and the taxonomy is associated with the provider in ProviderOne. If taxonomy is missing on Medicare claims passed to DSHS, these claims will deny.
DSHS does not receive TPL claims directly from other payers (other than Medicare). When billing DSHS directly for TPL coverage, follow DSHS rule about taxonomy (i.e., make sure the taxonomy is associated with the provider and that the taxonomy description aligns with the service).
More questions and answers about taxonomy can be found in the fact sheet Using Taxonomy in ProviderOne at http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR009%20taxonomy.pdf
Q: What are Medicare’s requirements around taxonomy related to Part B claims (not inpatient)?
A: Medicare does not require taxonomy codes be submitted in order to adjudicate claims, but will accept the taxonomy code, if submitted. However, taxonomy codes that are submitted must be valid against the taxonomy code set published at http://www.wpc-edi.com/codes/taxonomy. Claims submitted with invalid taxonomy codes will be rejected.
Q: Does the taxonomy code for professional billing drive the level of payment?
A: Taxonomy in ProviderOne will replace the type and specialty DSHS uses in the legacy MMIS. Claims are processed based on the national provider taxonomy assigned by DSHS or chosen by the provider during registration:
· Providers must include the taxonomy for billing and servicing (if applicable) providers on their claim since a single NPI can have more than one taxonomy.
· The taxonomy on the claim must be one of the taxonomies assigned to the NPI in ProviderOne.
· The billed service must be allowed by the taxonomy.