Taxonomy Codes

The Healthcare Provider Taxonomy Code (HPTC) is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct ‘Levels’ including Provider Type, Classification, and Area of Specialization.

The HPTC is designed for electronic use within the American National Standards Institute (ANSI) Accredited Standards Committee's (ASC) X12N health care transactions. This includes the transactions mandated under the Health Insurance Portability and Accountability Act (HIPAA). Distribution of the code set can be found on the Washington Publishing Company (WPC) website.

   

Claim Form Update

The National Uniform Claim Committee (NUCC) is responsible for the maintenance of the CMS-1500 form (the standard paper claim form to be used by non-institutional practitioners) and recently revised it. The new version, the CMS-1500 (08-05), has replaced the CMS-1500 (12-90) version. Effective July 1, 2007, Medicare will reject any 12-90 version forms received.

The CMS-1500 (08-05) claim form was updated to accommodate the National Provider Identifier (NPI), a unique provider number mandated by the Health Insurance Portability and Accountability Act (HIPAA). HIPAA requires that NPIs be used on electronic ANSI ASC X12N health care transactions. It does not require that NPIs be reported on paper claims, though Medicare has chosen to do so. Further information on the CMS-1500 form is available through the NUCC website.

   

National Provider Identifier

The National Provider Identifier (NPI) is a HIPAA Administrative Simplification Standard. The NPI is a unique identification number for covered health care practitioners. Covered health care practitioners and all health plans and healthcare clearinghouses will use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-digit number and beginning May 23, 2007 (May 23, 2008 for small insurers), the NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions (electronic). The CMS.gov website has a host of useful information as well as frequently asked questions.

   

Your Ideas Welcome

If you have topics you'd like to see addressed please let us know. Contact us at ProviderEducationSpecialist@cignabehavioral.com and we'll dig into it. We want this brief to be as informative and insightful as possible and to address topics important to our practitioner community.

   

Now Available on our Website

Have you missed any of our monthly eBriefs? As of February our monthly eBriefs are now available on our website at www.cignabehavioral.com for you to reference. Note: if you are having difficulty connecting via the link provided, highlight the link, copy, and paste into your browser.