Billing taxonomy code requirements
Please note, this communication applies to Anthem HealthKeepers Plus, Medallion and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) offered by HealthKeepers, Inc.
As a reminder, the Department of Medical Assistance Services (DMAS) and HealthKeepers, Inc. require all Anthem HealthKeepers Plus providers to include their respective billing taxonomy codes on paper and electronic claims. This is in addition to their billing National Provider Identifier (NPI). Ensuring the taxonomy codes are included will prevent adverse impacts on Anthem HealthKeepers Plus claims submissions to the Commonwealth of Virginia.
Additionally, for any claims submitted to Medicare for dual members, the taxonomy code with the appropriate qualifier is required to ensure accurate claims processing. HealthKeepers, Inc. has confirmed that even though Medicare does not require the billing taxonomy codes, Medicare will accept and transfer them to HealthKeepers, Inc. when the claims cross over.
Below are some tips for filing a complete and correct professional and institutional claim:
- For electronic claims submissions, consult the Commonwealth of Virginia’s encounter processing solution (EPS) claims submission rules, which dictate that the billing provider NPI is included in loop 2010AA, segment NM109, and taxonomy is included in loop 2000A, segment PRV03:
- Taxonomy code qualifier PXC is required with electronic submissions.
- For paper claims submissions, on a CMS-1500 form, the billing providers taxonomy code is required in box 33b in addition to the taxonomy code qualifier ZZ:
- Enter the two-digit ZZ qualifier directly followed by the taxonomy code. Do not enter a space, hyphen, or other separator between the qualifier and taxonomy.
- For paper claims submissions, on a UB-04 form, include the taxonomy code in box 81:
- Box 81-Code Field/Qualifiers:
- Enter the B3 as the qualifier directly followed by the taxonomy code if locations 76-79 contain an NPI. Enter the corresponding provider taxonomy code that is required for the provider’s NPI entered in locations:
- 76a – 81CCa
- 77b – 81CCb
- 78c – 81CCc
- 79d – 81CCd
If you have any questions about this communication, call Anthem HealthKeepers Plus, Medallion Provider Services at 800‑901‑0020 or Anthem CCC Plus Provider Services at 855‑323‑4687.
August 2022 Anthem Provider News - Virginia