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As a health care provider, it is necessary to choose a right taxonomy code to claim the money for your services. The specific taxonomy code (classified according to categories and sub-categories of various professions in the health care sector) enables you to receive a National Provider Identifier (NPI) number. All medical billing processes require the mention of the service provider’s NPI number. The U.S. Department of Health and Human Services (HHS), in compliance with the Health Insurance Portability and Accountability Act (HIPAA), uses NPI as a health care provider identification system to simplify administration standards. If you are a patient, awareness about the taxonomy code of your health care service provider could ensure a complete reimbursement of your insurance claims.
An NPI is necessary for all health care providers (under HIPAA standard administrative practices and financial transactions) and all those who make electronic transactions with the federal health programs. An NPI is required for billing purposes by health plans, health care providers and clearinghouses. As a patient, a listing of your provider’s NPI in your medical billing could bring you all the benefits of your chosen health plan or medical insurance.
Significance of Taxonomy Code
The taxonomy number is the unique alphanumeric 10-digit code listed for every general or specialized profession in the health care sector. For patients, it is essential to find the right taxonomy code of your health care provider while making any insurance claims. If you are a health care service provider, you need to choose a right taxonomy code to be paid for your services.
Listed Taxonomy Code
Health care providers are basically grouped as Individual or Groups (Physicians) and Non-individual (Hospitals or Laboratories). They are further grouped by hierarchy at three levels on the basis of type, classification and specialization, and the taxonomy code set is attributed to every category (primary code) and sub-category (secondary code) of a group. The Washington Publishing Co. provides the taxonomy code set at no charge. Providers choose a code that best represents their profession, and their individual NPI does not change even upon leaving an organization or changing professions. Request for modifications in taxonomy code number is submitted to National Uniform Claim Committee (NUCC), which maintains the health care service provider taxonomy code set. Any change in taxonomy code of the health care provider must be addressed to ensure correct billing for insurance claims (in the claims for the services offered as a provider and those utilized as a patient).
Uses of Taxonomy Code
The reporting of specific taxonomic codes simplifies the burden of administrative and billing processes in the health care sector. Also, as a service provider, you are free to choose more than one taxonomy code, provided you specialize in more than one area and hold the necessary certification. This gives an option to choose among the various health plans while making services claims. For example, a physician can report a primary taxonomic code for anesthesiology as 207L00000X, and report two secondary taxonomic codes for critical care medicine and pediatric anesthesiology as 207LC0200X and 207LP3000X, respectively, provided he specializes in both. If you are a patient and are making insurance claims, check the taxonomic code of your service provider to know if you are being billed correctly. If you are a service provider and are making services claims, choose the right taxonomic code for correct payment for your services.
Hailing out of Pittsburgh, Pa., David Stewart has been writing articles since 2004, specializing in consumer-oriented pieces. He holds an associate degree in specialized technology from the Pittsburgh Technical Institute.