Provider Alert! ZZ Taxonomy Qualifier Requirement and Billing Taxonomy Reminder

Date: September 23, 2022

Attention: All Providers

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Texas Children’s Health Plan would like to provide guidance for the ZZ taxonomy qualifier and the billing taxonomy claims requirements.

How this impacts providers:

ZZ Taxonomy Qualifier:

This communication is to notify providers that effective January 1, 2023 a ZZ taxonomy qualifier will be required for paper CMS-1500 professional claims.

Per National Uniform Claim Committee CMS-1500 Claims:

For box 33b, the qualifier, ZZ identifying the non-NPI number followed by the billing taxonomy code should be populated here. A space, hyphen, or other separator should not be entered between the qualifier and the billing taxonomy code.

Resource: https://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2021_07-v9.pdf

Billing Taxonomy:

As a reminder, the TMHP (Texas Medicaid and Healthcare Partnership) attested billing provider taxonomy code is also a claims requirement for all products. This should be placed in box 33b as previously described. Per TMPPM (Texas Medicaid Provider Procedures Manual), for CMS-1500 claims, claims must contain the billing provider’s complete name, physical address with zip+4 code, taxonomy, and benefit code (if applicable).

Resources:

https://www.tmhp.com/sites/default/files/microsites/provider-manuals/tmppm/html/index.html#t=TMPPM%2F1_06_Claims_Filing%2F1_06_Claims_Filing.htm&rhsearch=billing%20taxonomy%20&rhhlterm=billing%20taxonomy%20&rhsyns=%20

https://www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/16_1500

http://www.thecheckup.org/2019/01/10/provider-alert-follow-up-on-billing-provider-taxonomy-claims-requirement-effective-september-1-2018/

Next steps for providers: Providers should share this information with their staff. If this guidance is not followed claims will be rejected and returned for resubmission.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.