[
As previously communicated, AmeriHealth New Jersey commercial members will
be migrated to the new operating platform between September 1, 2015, and
October 1, 2015. Until the migration is completed, we will be working with you
in a dual claims-processing environment. As part of this transition and
thereafter, the use of taxonomy codes and a valid National Provider Identifier
(NPI) are required to ensure proper claims processing.
Using taxonomy codes
If your group 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.
The examples below illustrate how to correctly submit your taxonomy code:
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 |
Use a valid NPI for all claims
When submitting claims please be sure to use a valid NPI. This requirement
applies to all claims.
It is critical that you submit claims with a valid NPI, as the claims
processing system reviews each claim for this data. Providers should work with
their clearinghouse/trading partner to ensure accurate claims submission.
The most common reasons that an NPI would be considered invalid are:
- The NPI is terminated.
- The NPI is entered incorrectly.
- The number is invalid.
Using an invalid NPI could delay processing and payment. For additional
information about NPI regulations, implementations, reports, and resources, go
to the
NPI section of our website.
For the most up-to-date information about our upcoming transition of
AmeriHealth New Jersey commercial members to the new platform, we encourage you
to visit the System and Process Changes section of the Provider News
Center.
]