Healthcare Provider Taxonomy Codes (HPTC): October 1, 2009 Update

Provider Types Affected
Providers who bill Carriers including J1 A/B MAC.

Provider Action Needed
CMS has released the summary of changes reflected in the Health Care Provider Taxonomy Code (HPTC) list. Medicare carriers and J1 A/B MACs will update their HPTC tables with this new version effective on October 1, 2009.

What You Need to Know
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.

What You Need to Do
Please review the information included here and stay current on all HIPAA requirements to assure timely processing of your claims.

Background
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.

HIPAA requires that submitted data, which is part of a named code set, must be valid data from that code set. The health care provider taxonomy is a named code set in the 837 professional implementation guide, thus carriers must validate the inbound taxonomy codes against their internal HPTC tables.