Claims & Billing
Use these helpful tips when billing taxonomy codes

​​​​As a reminder, taxonomy codes are required on all claims to ensure proper claims processing and payment.

We've recently made changes to back-end matching logic for taxonomy codes, which will continuously improve the overall claim adjudication process.

Note that failure to submit claims with the applicable NPI and correct correlating taxonomy code will result in claim denials that must be corrected prior to payment consideration.

It's important that you work with your third-party billing agency and/or clearinghouse to ensure compliance with these requirements.

Review these tips for compliant billing practices related to taxonomy codes.

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​Topic​​
 ​Action
 ​Resource

​Claim submissions

​You must bill taxonomy codes for both the billing and rendering provider or claims will be denied.

​Requirements for billing with taxonomy codes

​Claim corrections

​If you need to correct a previously submitted paper, electronic, or 1500 claim via Practice Management on the Provider Engagement, Analytics & Reporting (PEAR) portal, you must submit a corrected claim including the frequency type code and required fields.

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Reminder: Corrected claim submission procedures

Corrected Claims Job Aid: PEAR Help Center


​Specialty changes

​If you need to make changes to your practicing specialty, you must submit the proper form for consideration. 

​Guidelines for billing with taxonomy codes


Claim submissions

Review the visuals below for accurate paper and PEAR portal 1500 claim submissions:

  • ​CMS 1500 claim form submissions:
    23-0201_IBX_1_1.png
  • UB-04 claim form submissions:

    23-0201_IBX_2_1.png
  • PEAR Practice Management – 1500 Claim Submissions:

    23-0201_IBX_3_1.png


For guidance on electronic claim submissions, please review the claim submission guides on our website.

Claim corrections

Review the visuals below to submit a corrected paper claim.

  • CMS 1500 claim forms:
    Box 22 – Resubmission and/or Original Reference Number
    Follow the instructions from the National Uniform Coding Committee (NUCC) billing requirements:
    • List the original reference number for resubmitted claims.
    • When submitting a claim, enter the appropriate resubmission code in the left-hand side of the field.
      • 7 = Replacement of prior claim
      • 8 = Void/cancellation of prior claim
    Example:
    23-0201_IBX_4_1.png

  • ​UB-04 claim forms:
    Field location 4 – Type of Bill – Frequency Code
    When submitting a claim, enter the appropriate Frequency Code in the fourth position of the Type of Bill:
    • 5 = Late Charge(s) only
    • 7 = Replacement of prior claim
    • 8 = Void/cancellation of prior claim

    Field location 64 – Document Control Number
    This field is used to capture the original reference/claim number, which is required for corrected claims.​
    23-0201_IBX_5_1.png


Review the visuals below from the Corrected Claims Job Aid on the PEAR Help Center for steps to submit a corrected claim in the PEAR portal.

23-0201_IBX_6_1.png

For additional questions, please call Provider Customer Service at 1-888-YOUR AH1 (1-888-968-7241) for New Jersey or 1-800-275-2583 for Pennsylvania. Visit our dedicated Platform Transition page to view an archive of communications related to the transition.​

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