Provider Taxonomy
July 2024
Whether you are a general dentist, a specialist, a single provider, or a group/facility, your taxonomy has an impact on your billing. Healthcare taxonomy is a code set used to classify different types of providers and their specialties. Data related to these categorizations directly impact insurance claims processing and structured reimbursement models. When is the last time you reviewed your taxonomy?
Selecting Taxonomy
Healthcare taxonomy is a unique, multi-level code set that allows the provider to select and identify their specialty. The code set system is currently maintained by the National Uniform Claim Committee (NUCC) with code updates and modifications released every January and July. For more information and a full searchable list visit: https://taxonomy.nucc.org.
Common examples:
|
Dentist |
122300000X |
|
Periodontics |
1223P0300X |
|
Oral and Maxillofacial Surgery |
1223S0112X |
|
General Practice |
1223G0001X |
Registering Taxonomy
A taxonomy selection is linked to your National Provider Identifier (NPI), your Medicare enrollment, and often your individual insurance provider profile.
NPI: Visit https://nppes.cms.hhs.gov to search the national NPI registry to see your currently registered taxonomy and submit updates for both your individual NPI and your practice/group NPI.
Medicare: Providers participating in Medicare have a Medicare specialty code that classifies their area of specialization. Visit https://data.cms.gov/provider-characteristics/medicare-provider-supplier-enrollment/medicare-provider-and-supplier-taxonomy-crosswalk for a document that “crosswalks” these specialty codes to taxonomy codes.
Insurance: In addition to NPI registered taxonomy, commercial payers often maintain their own provider records with information obtained at the time of credentialing. Use payer portals and customer service representatives to help review taxonomy details and submit updates as needed.
Impact on Billing
Claims processing can be a complex process that increasingly relies on the interconnectivity of electronic data. Many dental CDT codes and medical CPT codes require the rendering/billing provider to have specific registered taxonomy codes to be authorized for coverage or payment. So, if you are encountering claim rejections or denials related to your NPI it may be time to review your registered taxonomy codes (see above). While it may seem like a “set it and forget” classification, remember that both procedure codes and taxonomy codes are updated annually – which means you should be taking a quick yearly look too!
Dental Billing & Consulting Professionals is also happy to be a resource to you in this process. Our services are customized to each practice’s specific needs and goals. Call or text us any time at (860) 435-7344 for a free consultation on how we can support you in optimizing your billing.