Provider Alert! Reminder of Updated Rendering Provider Edit Requirements

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:

Scenario One	Action
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:

Loop /Segment	Description
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)

 

332B00000X

332S00000X

261QA0600X

261QD1600X

305R00000X

311ZA0620X

253J00000X

261QM0850X

261QM3000X 261QR0405X

3104A0630X

251B00000X

101YP2500X

146D00000X

171M00000X

333300000X

335E00000X

251S00000X

251C00000X

251E00000X

251G00000X

253Z00000X

261Q00000X

177F00000X

193200000X

174200000X

332U00000X

310400000X

313M00000X

314000000X

372500000X

373H00000X

376K00000X

225X00000X

171W00000X

171WH0202X

171WV0202X

347C00000X

225100000X

251J00000X

374U00000X

3747P1801X

372600000X

376J00000X

385HR2050X

385HR2055X

385HR2060X

385HR2065X

261QH0700X

261QM0801X

305S00000X

 

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.

Resource: https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2022/2022-11-november/1_01_Provider_Enrollment.pdf

CPT/HCPCS

• 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

12 Home
25 Birthing Center
31 Skilled Nursing Facility
32 Nursing Facility
33 Custodial Care Facility
34 Hospice

41 Ambulance-Land
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: providerrelations@texaschildrens.org.

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