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Medicare News Update Medicare Information Resource
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MIR-2006-7AB, July 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Update to the Healthcare Provider
Taxonomy Codes (HPTC) Version 5.1
Provider Types Affected
Physicians, suppliers, and providers billing Medicare carriers, including Durable Medical Equipment Regional Carriers (DMERCs)
Provider Action Needed
Impact to You
This article is based on Change Request (CR) 4072, which includes details regarding the Version 5.1 HPTC update.
What You Need to Know
CR4072 advises your carrier and/or DMERC to obtain the Healthcare Provider Taxonomy Code list Version 5.1 and use it to update their internal HPTC tables to process your claim(s) correctly.
What You Need to Do
Please see the Background section of this article for further details regarding this update.
Background
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that submitted data, which is part of a named code set, be valid data from that code set. Claims with invalid data are noncompliant.
Because healthcare provider taxonomy is a named code set in the American National Standards Institute (ANSI) X12N 837 Professional Implementation Guide, Medicare carriers, including DMERCs, must validate the inbound taxonomy codes against their internal HPTC tables.
The HPTC is an external non-medical data code set designed for use in classifying healthcare providers in an electronic environment according to provider type, or practitioner specialty. HPTCs are scheduled to be updated twice per year (April and October).
The updated code list is available from the Washington Publishing Company at http://www.wpc-edi.com/codes/taxonomy.asp in two forms:
- Free Adobe PDF download; and
- Available for purchase, an electronic representation of the list, which will facilitate the automatic loading of the code set.
CR4072 advises your carrier and/or DMERC to use the most cost-effective means to obtain the Version 5.1 HPTC list and update their HPTC tables as necessary.
Implementation
The implementation date for the instruction is October 3, 2005.
Additional Information
To summarize the changes in Version 5.1, the following taxonomy codes are added:
- 170300000X
- 171000000X
- 1710I1002X
- 1710I1003X
For complete details, please see the official instruction issued to your carrier/DMERC regarding this change at http://www.cms.hhs.gov/transmittals/  on the CMS Web site. From that Web page, look for CR 4072 in the CR NUM column on the right, and click on the file for that CR.
If you have any questions, please contact your carrier/DMERC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNum Directory.pdf  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
Medlearn Matters Number: MM4072
Pub. 100-4, Transmittal# 694, CR# 4072
Related CR Release Date: September 30, 2005
Effective Date: October 30, 2005
Implementation Date: October 30, 2005
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