Providers who bill carriers including DME MAC.
CMS has released the summary of changes reflected in the Health Care Provider Taxonomy Code (HPTC) list. Medicare carriers and DME MACs will update their HPTC tables with this new version effective on April 1, 2011.
The Health Insurance Portability and Accountability Act (HIPAA) requires that submitted data, which is part of a named code set, be valid data from that code set. Claims accepted with invalid data are non-compliant.
Please review the information included here and stay current on all HIPAA requirements to assure timely processing of your claims.
Under HIPAA, code sets that characterizes a general administrative situation, rather than a medical condition or service, are referred to as non-clinical or non-medical code sets. The provider taxonomy code set is an external non-medical data code set designed for use in classifying health care providers according to provider type or practitioner specialty in an electronic environment, specifically within the American National Standards Institute (ANSI) Accredited Standards Committee (ASC) health care transaction.
- J11 Part A and HHH: (866) 749-4301
- Part B (Ohio and West Virginia): (866) 308-5438
- Part B (South Carolina): (866) 749-4301