The Importance of Accurate Taxonomy Codes

Date Issued: 6/22/2018

Taxonomy codes are administrative codes that identify your provider type and area of specialization. It is a unique ten character alphanumeric code that enables you to identify your specialty at the claim level. We want to make sure you know how this will affect you and your EmblemHealth patients.

What is happening

Starting on September 11, 2018, if your taxonomy code is invalid or your taxonomy indicates you do not have the right to prescribe certain drugs, pharmacies using Express Scripts, Inc. (ESI)—our primary pharmacy network—will not fill your patients’ prescriptions, even if it is a refill of a previous prescription.

Why this is happening

Express Scripts, Inc. is following New York prescriptive authority logic, which compares the drugs being prescribed with a prescriber’s taxonomy in the National Plan and Provider Enumeration System (NPPES).

To avoid getting calls from upset patients and multiple pharmacies, update your taxonomy codes. Don’t let your patients get turned away at the pharmacy.

What you need to do

  • Review the Medicare taxonomy crosswalk to see which taxonomies are eligible to prescribe.
    • Go to cms.gov and search “Crosswalk Medicare Provider/Supplier to Healthcare Provider Taxonomy.”
  • Update your taxonomy code(s), if necessary.
    • Go to npiregistry.cms.hhs.gov.
    • Enter your National Provider Identifier (NPI) in the National Plan and Provider Enumeration System (NPPES).
    • Click on the NPI number. Scroll to the bottom of the record to see your taxonomies.
    • If the taxonomy is not a valid CMS taxonomy,
      go to nppes.cms.hhs.gov/NPPES/Welcome/do.
      Enter your username and password in the individual NPI portion of the site and update the taxonomy code as needed. Please make sure you select a taxonomy that belongs to an individual provider, not an entity.

Refer to the example below to learn more about how to make sure your taxonomy code accurately reflects what you do. For more information:

  • Go to cms.gov.
  • Click on the Medicare tab at the top of the page.
  • Scroll to the Provider Enrollment & Certification section.
  • Click on Medicare Provider-Supplier Enrollment.
  • Scroll to the bottom.
  • Click on Taxonomy in the left navigation.

Tip for Selecting the Correct Taxonomy Code

Avoid General Codes

We strongly encourage physicians and other prescribers to avoid choosing the very general taxonomy codes below. They may inappropriately identify the prescriber as someone who cannot write prescriptions for patients, resulting in a rejected prescription.

  • Specialist
  • Contractor
  • Hospital
  • Clinic

Individuals should avoid choosing a taxonomy that represents a facility. Instead, select the taxonomy for your actual specialty.

For Nurses

If you are a nurse and have an advanced practice degree, we urge you to avoid selecting “Registered Nurse” as a taxonomy for the same reason stated above. Your taxonomy code should reflect that you have an advanced practice nursing degree to ensure accurate identification of what you do and to avoid unnecessary rejects.