Provider Alert! Reminder of Updated Rendering Provider Edit RequirementsTexas Children's Health Plan
Date: November 10, 2022
Attention: All Providers
Effective Dates: June 21, 2022 for rendering edit requirements
Further clarification provided: November 10, 2022
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 the nature of the COVID-19 Event.
Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers of billing requirements for the rendering provider taxonomy on professional claims. Our contracted clearinghouse, Change Healthcare (CHC), will reject any claims that do not contain proper Billing Provider Taxonomy Numbers, Billing Providers NPI’s, and/or rendering provider taxonomy when applicable.
Rendering Taxonomy code billing requirements can differ depending on the following:
- Rendering National Practitioner Identification (NPI) is different than the Billing NPI
- Rendering NPI is the same as the Billing NPI
The rendering provider taxonomy is required when the rendering provider is different than the billing NPI. This information submitted must match the State’s Master Provider File effective on the date of service for the claim.
Resource: TMPPM Section 6.1.2, Claims Filing Instructions
Below are scenarios to serve as guidance with the Rendering Taxonomy Code Billing Requirements:
|Rendering NPI is different than the billing NPI.||Rendering Taxonomy is required.|
|Rendering NPI and Billing NPI are the same.||Rendering Taxonomy is not required.|
How this impacts providers: Here is a summary of the required fields for Professional 837P (CMS/1500) Claims:
|2000A PRV (billing taxonomy required) *
2300 CLM05-01 (header, place of service code)
2400 SV105 (service detail, place of service code)
|§ The billing provider taxonomy is required on all claims.
§ The rendering provider name, NPI, and Taxonomy are required on Professional claims when Rendering Provider information is submitted at the claim and/or service line level. Taxonomy and NPI used should be those attested with at Texas Medicaid.
§ There are no attestation checks at CHC; this is done at TCHP for billing provider and rendering provider.
§ CHC will check the following:
§ Each detail service line. If “ALL” lines do not meet exemption Place of Service (POS) list, the edit for rendering provider/taxonomy will appear and
§ CHC will also check the header and service detail line POS values.
§ TCHP’s contracted clearinghouse, CHC, will reject any claims that do not contain proper Rendering Provider Taxonomy Numbers and/or Rendering Providers NPI’s
|2310B PRV Rendering Provider Taxonomy||§ Taxonomy and NPI used should be those attested with Texas Medicaid
*2000A PRV (Billing Taxonomy to Bypass)
Further clarification: The following CPT/HCPCS and Place of Service codes do not require a rendering provider taxonomy when the billing and rendering provider are the same. As it is not part of their TMHP enrollment requirement.
- Radiology CPT Codes 7xxxx
- Anesthesiology CPT Codes 00100-01999
- Pathology/Labs CPT Codes 8xxxx
- Proprietary Laboratory Analyses CPT Codes 0001U-0241U
- Home Health – T1019-T1022
- Durable Medical Equipment – E0100-E8002, K0001-K0900, L0112-L4631, L5000-L9900
- Transportation – A0021-A0999 and T2001-T2007
- Dialysis Services – 90935-90999
- Long Term Services Supports — S5101, T1019, S5161, S5160, G0162, T1000, T1025, T1026, T2002, T2040, T1005, T2027, H2015, T2028, T2029, T2039, S5165, T2038, H2025, H2023
Place of Services
10 Telehealth Provided in Patient’s Home
25 Birthing Center
31 Skilled Nursing Facility
32 Nursing Facility
33 Custodial Care Facility
42 Ambulance- Air or Water
50 Federally-Qualified Health Center
62 Comprehensive Inpatient Rehabilitation Center
65 End-Stage Renal Disease Treatment Facility
72 Rural Health Clinic
81 Independent Laboratory
Next steps for providers: Providers should share this reminder with their billing staff and ensure proper rendering provider taxonomy information (if applicable) are submitted when submitting claims.
If you have any questions, please contact your Provider Relations Liaison or email the Provider Relations Department at: firstname.lastname@example.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers
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