Reminder: Taxonomy Requirements

Date: 02/14/25

As a reminder, pursuant to instruction in both the DMMA billing guidelines and Delaware First Health’s Provider Billing Manual, all claims must be submitted with the billing, rendering, and attending provider’s taxonomy.

Claims submitted without the required taxonomy will be DENIED or REJECTED.

Below is the placement for taxonomy codes for paper and electronic claims submissions.

CMS-1500 Paper Submission	837P Electronic Submission
* Rendering – Box 24i should contain the qualifier “ZZ”. Box 24j (shaded area) should contain the taxonomy code.	* Rendering – Loop 2310B PRV01 = “PE”; PRV02 = “PXC” qualifier; PRV03 = 10-character taxonomy code002E.
* Billing – Box 33b should contain the qualifier “ZZ” along with the taxonomy code.	* Billing – Loop 2000A PRV01 = “BI”; PRV02 = “PXC” qualifier; PRV03 = 10-character taxonomy code.

 

CMS-1450/UB-04 Paper Submission	837I Electronic Submission
*Attending – Box 81CCb should contain the qualifier “B3” in the left column and the taxonomy code in the middle column.	*Attending – Loop 2310A PRV01 = “AT”; PRV02 = “PXC” qualifier; PRV03=10-character taxonomy code
* Billing – Box 81CCa should contain the qualifier “B3” in the left column and the taxonomy code in the middle column.	* Billing – Loop 2000A PRV01 = “BI”; PRV02 = “PXC” qualifier; PRV03 = 10-character taxonomy code.

 

PLEASE NOTE: Your clearinghouse must make taxonomy placement a permanent placement on your account.

If your claim is denied for missing taxonomy, a corrected claim must be submitted within 90 calendar days of the date of the EOP or as defined in your contract with Delaware First Health.

If your claim is rejected for missing taxonomy, a new claim must be submitted within 120 calendar days from the date of service and must include the taxonomy in the required fields as listed above.

For more information regarding billing requirements, access our provider manual and billing manual  on our website.