July 7, 2022
The recent expansion of our claim editing system includes several edits that use the rendering provider's specialty. The most reliable source to identify the correct specialty is the rendering provider's taxonomy code. If the taxonomy code is not on the claim form, the edits will then have to rely on the specialty description attached to the provider record in Premera's provider database, whether correct or not.
To assist in applying claim edits correctly, providers are strongly encouraged to add their specialty taxonomy code to their claim forms when submitting to Premera.
On a CMS-1500 paper claim, the taxonomy code is entered utilizing two fields on the claim form:
- Field 24I (upper shaded portion) = ID Qualifier: enter "ZZ"
- Field 24J (upper shaded portion) = rendering provider taxonomy code: enter the 10-digit taxonomy code
On an 837P/5010A1 electronic claim form, the taxonomy code is entered:
- ID qualifier: "PXC" = Loop 2310B – PRV03
- Rendering provider taxonomy code: Loop 2420B – PRV03