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02/01/2023
In the most recent ACS build (1.16) effective on January 12, 2023, an edit was activated to validate taxonomies and claim form compatibility. Some taxonomies are no longer acceptable on Professional claim forms/files. Current affected providers may have started seeing this denial reason on recent RA’s.
Taxonomy Invalid for Claim Form denial reason was added to be consistent with an edit added by NCTracks effective 7/1/2022. This edit will be applied when the billing provider taxonomy code submitted on a PROFESSIONAL claim is any of the below:
251E00000X, 251G00000X, 261QE0700X, 275N00000X, 282N00000X, 282NC0060X, 283Q00000X, 284300000X, 311ZA0620X, 313M00000X, 314000000X, 315P00000X, 320800000X or 323P00000X.
The above taxonomies are only permitted on INSTITUTIONAL claims.
What do providers need to do to address this change?
There is guidance in the Billing & Enrollment manual for how to enter an institutional claim into the portal or work with your clearinghouse to send the claim in an 837I file.
If providers do not currently have an alternative appropriate taxonomy in NCTracks or do not want to submit an institutional claim, providers will need to submit a Manage Change Request to NCTracks to add an appropriate taxonomy as necessary.
Questions may be directed to: [email protected]