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2017-02 Including Correct Taxonomy on Claims

Date: 01/23/17

Louisiana Healthcare Connections will implement the following claims processing edits, effective immediately on all claims with service dates Dec. 1, 2016, and beyond.

  • All providers (group and individual) must have a taxonomy on file with Louisiana Healthcare Connections.
  • If a provider has multiple taxonomies on file, submitted claims must specify a taxonomy.
  • The taxonomy on submitted claims must match one taxonomy in Louisiana Healthcare Connections’ registry.
  • Only providers who have a single taxonomy on file with Louisiana Healthcare Connections may submit claims without a taxonomy.
  • Taxonomy requirements apply to boxes 24J and 33B on the CMS-1500 professional claim form and box 57 or box 81 on the CMS-1450/UB-04 facility claim.
  • Requirements do not apply to atypical provider types that do not require an NPI.
  • Effective Feb. 3, 2017, the taxonomy code requirement will not apply to the attending provider on the CMS-1450/UB-04.

NOTE: If a provider does not have a taxonomy on file with Louisiana Healthcare Connections, or if a claim includes a taxonomy that does not match the taxonomy on file, the claim will be rejected with Rejection Code 91: Invalid or Missing Taxonomy Code.

To check what taxonomy is on file, please follow these steps:

  1. Login to our provider portal at www.LaHealth.cc/ProviderPortal and click Reports.
  2. Select “Verify Demographic and Practitioner Info” to open spreadsheet. (For instructions on updating demographic information, please see “Verify Demographic and Practitioner Info – Instructions” in the reports section of the provider portal.)
  3. The provider taxonomy is listed in column G; practitioner taxonomy is column BT. If the updated information is not reflected in the provider portal within 15 business days, please contact your dedicated Provider Relations Consultant or call Provider Services.

To add or change a taxonomy in Louisiana Healthcare Connections’ registry, please mail a letter of request on your company’s letterhead, or fax it to 1-866-768-9374. Louisiana Healthcare Connections, ATTN: Provider Contracting P.O. Box 84180, Baton Rouge, LA 70884

OR update your taxonomy at https://nppes.cms.hhs.gov and notify us via phone.