HIP and Vytra Dual Specialty Providers: Include Taxonomy Code on Claims

Date Issued: 12/3/2012

We strive to provide the most accurate and timely reimbursement to our clinicians who are dual specialty providers, practicing both as PCPs and specialists. To ensure an excellent claims-paying experience, we request that you include the taxonomy (specialty) code for the specialty in which you provided services.

By including the taxonomy qualifier and value on the CMS 1500 form in columns 24I and 24J, or in Loop 2000A, segment PRV03; Loop 2310B, segment PRV03; or Loop 2420A, segment PRV03 for electronically submitted claims, we can determine the correct copayment to deduct.

Note: This request applies to professional claims for HIP and Vytra lines of business and only for services rendered in the following locations:

  • POS 11 – Office
  • POS 12 – Home
  • POS 22 – Outpatient department of a hospital

You can view the Health Care Provider Taxonomy Code Set at www.wpc-edi.com/reference.