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Guidelines for billing with taxonomy codes

May 30, 2014

As previously communicated, we are in the process of transitioning AmeriHealth Pennsylvania members to a new operating platform. During this transition, which began in January 2014 and will continue through mid-2015, we will be working with you in a dual claims-processing environment. As part of this transition, the use of taxonomy codes is required to ensure proper claims processing.

Using taxonomy codes

If your group National Provider Identifier (NPI) is associated with more than one AmeriHealth specialty, you must include the appropriate provider taxonomy code in addition to the NPI on all claims. This allows the accurate application of the provider?s contractual business arrangements with AmeriHealth. Failure to submit claims with the applicable NPI and correct correlating taxonomy code may result in incorrect claims processing and/or payment delays.

Example 1 Incorrect billing practice Billing NPI Specialty description Taxonomy code Taxonomy description 12345XXXXX Durable medical equipment 332B00000X Durable medical equipment Rendering NPI Specialty description Taxonomy code Taxonomy description 11223XXXXX Durable medical equipment 333600000X Pharmacy

Correct billing practice Billing NPI Specialty description Taxonomy code Taxonomy description 12345XXXXX Durable medical equipment 332B00000X Durable medical equipment Rendering NPI Specialty description Taxonomy code Taxonomy description 11223XXXXX Durable medical equipment 332B00000X Durable medical equipment

Example 2 Incorrect billing practice Billing NPI Specialty description Taxonomy code Taxonomy description 12345XXXXX Home infusion/Durable medical equipment 3336H0001X Home infusion/Durable medical equipment Rendering NPI Specialty description Taxonomy code Taxonomy description 11223XXXXX Home infusion/Durable medical equipment 333600000X Pharmacy

Correct billing practice Billing NPI Specialty description Taxonomy code Taxonomy description 12345XXXXX Home infusion/Durable medical equipment 3336H0001X Home infusion/Durable medical equipment Rendering NPI Specialty description Taxonomy code Taxonomy description 11223XXXXX Home infusion/Durable medical equipment 3336H0001X Home infusion/Durable medical equipment

For more visit our System and Process Changes section of the AmeriHealth website. Here you will find a communication archive and frequently asked questions.


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