Healthcare provider taxonomy code set update


Background

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that covered entities use the standards adopted under this law for  lectronically transmitting certain health care transactions, including health care claims. The standards include implementation guides which dictate when and how data must be  sent,including specifying the code sets which must be used. The institutional and professional claim electronic standard implementation guides (X12 837-I and 837-P) each require use of valid codes contained in the HPTC set when there is a need to report provider type or physician, practitioner, or supplier specialty for a claim.

The National Uniform Claim Committee (NUCC) maintains the HPTC set for standardized classification of health care providers, and updates it twice a year with changes
effective

April 1 and October 1. These changes include the addition of a new code and addition of definitions to existing codes. You should note that:

1. Valid HPTCs are those that the NUCC has approved for current use;

2. Terminated codes are not approved for use after a specific date;

3. Newly approved codes are not approved for use prior to the effective date of the code set update in which each new code first appears; and

4. Specialty and/or provider type codes issued by any entity other than the NUCC are not valid.

CR 9461 implements the NUCC HPTC code set that is effective on April 1, 2016, and instructs MACs to obtain the most recent HPTC set and use it to update their internal HPTC tables and/or reference files. The HPTC set is available for view or for download from the Washington Publishing Company (WPC) at http://www.wpc-edi.com/
codes.

When reviewing the HPTC set online, you can identify revisions made since the last release by the color code:

*** New items are green;

*** Modified items are orange; and

*** Inactive items are red.

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