Provider Alert! Correction to Rendering Provider Guidance Previously Provided
Date: December 16, 2022
Attention: All Providers
This communication is an update to the communication providedon November 23, 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 23,2022.
How this impacts providers: TCHP would like to remind providers that both the Taxonomy and NPI number are required on all claims submission forms. TCHP will reject professional claims without a valid rendering taxonomy code and NPI number. 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 and NPI information are submitted on claims.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
