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Guidelines for billing with taxonomy codes and use of NPI on claims

July 31, 2015

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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 NPISpecialty descriptionTaxonomy codeTaxonomy description
12345XXXXXDurable medical equipment332B00000XDurable medical equipment
Rendering NPISpecialty descriptionTaxonomy codeTaxonomy description
11223XXXXXDurable medical equipment333600000XPharmacy
Correct billing practice
Billing NPISpecialty descriptionTaxonomy codeTaxonomy description
12345XXXXXDurable medical equipment332B00000XDurable medical equipment
Rendering NPISpecialty descriptionTaxonomy codeTaxonomy description
11223XXXXXDurable medical equipment332B00000XDurable medical equipment

Example 2
Incorrect billing practice
Billing NPISpecialty descriptionTaxonomy codeTaxonomy description
12345XXXXXHome infusion/Durable medical equipment3336H0001XHome infusion/Durable medical equipment
Rendering NPISpecialty descriptionTaxonomy codeTaxonomy description
11223XXXXXHome infusion/Durable medical equipment333600000XPharmacy
Correct billing practice
Billing NPISpecialty descriptionTaxonomy codeTaxonomy description
12345XXXXXHome infusion/Durable medical equipment3336H0001XHome infusion/Durable medical equipment
Rendering NPISpecialty descriptionTaxonomy codeTaxonomy description
11223XXXXXHome infusion/Durable medical equipment3336H0001XHome 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.

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