Provider Alert! Correction to Rendering Provider Guidance Previously Provided

By Texas Children's Health Plan Provider Alert 0 Comments

Date: November 23, 2022

Attention: All Providers

This communication is a correction to the communication provided on 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 nature of the COVID-19 event.

Call to action: Please note this communication is a correction to the communication provided on November 10,2022.

How this impacts providers: TCHP would like to remind providers of the rendering provider taxonomy requirements for professional CMS claims. TCHP will reject professional claims without a valid rendering taxonomy code. Please see the below table as reference for electronic claim submissions.

Required Data Element	Paper CMS 1500	Electronic – CMS 1500
Billing Provider Taxonomy	Box 33b with qualifier ZZ	Loop ID – 2000A Segment – PRV03
Rendering Provider Taxonomy	Box 24j – shaded area with qualifier ZZ in 24i	Loop ID – 2310B Segment – PRV03 Loop ID – 2420A Segment – PRV03
Required Data Element	CMS 1450 (UB-04)	Electronic – CMS 1450 (UB04)
Billing Provider Taxonomy	Box 81CC with qualifier B3	Loop ID – 2000A Segment – PRV03
Rendering Provider Taxonomy	Not Applicable (n/a)	Not Applicable (n/a)

If these data elements are missing or invalid, claim will be rejected with the following message(s)

REQ: BILLING TAXONOMY REQUIRED
REQ: CLAIM LEVEL RENDERING PROV

Provider taxonomy (rendering and billing) will be considered invalid if the submitted

taxonomy is not one of the taxonomies with which the provider record is enrolled with

Texas Medicaid & Healthcare partnership (TMHP). It is critical that the taxonomy code

selected as the primary or secondary taxonomy code during a provider’s enrollment with

TMHP is included on all electronic and paper transactions.

Note that rejected claims do not count as clean claims. Please ensure that claims are

submitted within 95 days from the date of service. Per the Health and Human Services Commission contract requirements, a clean claim must have all the necessary data for the claim processor to adjudicate and accurately report the claim. A Clean Claim must meet all the requirements for accurate and

complete data as defined in the appropriate claim type encounter guides.

Next steps for providers: Providers should share this communication with their billing staff and ensure proper taxonomy information are submitted on claims.

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.

Provider Alert! Correction to Rendering Provider Guidance Previously Provided