261QC0050X Critical Access Hospital. 3. As a provider, do I need to know my taxonomy code? Enter the patient's Medicaid identification number 2 . Taxonomy Code Example: 282N00000X . CMS-1500 FORM FIELDS & DESCRIPTION FIELD NUMBER & DESCRIPTION 1. The NUCC is the entity which created and maintains the CMS-1500 form. identification and/or taxonomy numbers are either missing or do not match the records on file. It is not intended to allow the billing of 12 lines of . Display the NPI# according to the rules below. Gain insight into the top 5 regulatory and reimbursement changes that will impact the healthcare industry A lock icon or https:// means youve safely connected to the official website. Note: You may select more than one code or code description when applying for an NPI, but you must indicate one of them as the primary code. Pro-Tip: Remember that the taxonomy code must be for the rendering provider, meaning the provider who actually performed the services. 12, 13 Select the option Signed Signature Auth. . Gavin. Fields 66 . DOS FROM & TO entered in Charge Entry/Charge Master screen. "=f IF:[.`W_"vy.Ml~XL*Mc` ?
Type the taxonomy code in the Other ID (17a) text box. 30 Displays TOTAL BALANCE AMOUNT for this claim, 31 Displays RENDERING PROVIDER NAME, SIGNATURE ON FILE & CLAIM DATE. Taxonomy codes on electronic claim submissions with the ASC X12N 837I format are placed in below-listed data elements in respective Segment and Loop. . Patient DOB and SEX from Patient Master. If no rendering provider is placed in Box 31, then the Taxonomy Code should be placed . In accordance with SNIP level 4 edits, a valid taxonomy is a requirement for all providers when submitting both paper and electronic claims. How to TRANSITIONING/TRANSFERRING OF ENROLLEES to MCO, What is Patient driven Grouping model how its working, Workers Compensation Medicare Set-Aside Arrangement (WCMSA) Full coverage, Understanding Medicare cost Reports and usage. endstream
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<. Display Y if FAMILY PLAN check box is selected under Others tab in Charge Entry. It is a one-of-a-kind 10-character code that denotes your classification and specialization. %%EOF
Rendering Provider along with Taxonomy is required when Billing Taxonomy is 193200000X or 193400000X. Qualifiers are to be included on both paper and electronic claims for proper submission of claims The California Billing and Payment Guide issued by the Division of Workers Comp (DWC) requires providers to complete the CMS-1500 Form with the taxonomy code of the rendering provider when the rendering provider is a health care provider. 4. 12 & 13 are on file and enter the SIGNATURE DATE under Authorization Information section in Other Attributes page in Patient Master. Primary care (pcp) 363AM0700X. Providers must enter this taxonomy code in both the billing and the servicing taxonomy fields on the CMS-1500 (HCFA) claim form. The NUCC provider taxonomy codes can be very detailed and will provide enough granularity for most research purposes. Professional claims. Official websites use .govA Taxonomy Code in the shaded area. For a specific payer, please see: Box 33: Insurance Specific Billing Provider. Claims Denied - Taxonomy Codes Missing, Incorrect, Or Inactive. July 1, 2022. . 1.a. As such, all providers with NPIs will have self-identified with at least one provider taxonomy code. hb``d``c ,l@qm{$9'' O=ME#+:::@ i VT03- `t0e
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For paper claims submissions, on a UB-04 form, include the taxonomy code in box 57 or in box 81. 6. BILLING PROVIDER TAXONOMY CODE IS REQUIRED. For paper claims submissions, on a CMS-1500 form, include the taxonomy codes in box 33b. 1.a. Taxonomy Code Requirement effective March 1, 2017 Updated February 9, 2017 . It complies with the National Standardized Billing Standards and is required for the accurate and timely claim processing. [On the bottom non-colored area]. 33.b. 2433 0 obj
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Each taxonomy code is a unique ten character alphanumeric code that enables providers to identify their specialty at the claim level. Select Provider Taxonomy from the Qualifier (17a) drop-down menu. 0
Patient GROUP # of the other payer in Insurance Information screen under Patient Master. The anesthesiology codes cannot be used to derive COS 030. .gov 010 Physicians : 837P . Please contact the Provider Relations department at x-xxx-xxx-xxxx to resolve this issue. endstream
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An official website of the United States government [On the Top Colored area] NPI# or the rendering provider from Provider Master. Nearly two months after NC Medicaid Managed Care launch, PHPs continue to see the billing issue of professional and institutional EDI claims (ASC X12 837-P and ASC X12 837-I) with missing or invalid (non-taxonomy values or non-enrolled taxonomy codes) billing provider, rendering provider, and/or attending provider taxonomy codes. POS selected in the Charge Entry/Charge Master screen. Click Save Information. or Claim Form for both Block Kaiser Permanente also requires that all CMS-1450 claims submitted are reported using the specific code sets as adopted by HIPAA. 1. If you need help identifying your taxonomy code, or have other questions about the enrollment process, please contact us. To enroll, you must have an NPI. endstream
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(Required if applicable.) Below are three scenarios with Billing Requirements for each scenario. On electronic claim submissions using the ASC X12N 837P and 837I format, taxonomy codes are placed in segment PRV03 and loop 2000A for the billing stage, and segment PRV03 and loop 2420A for the rendering level. Yes, if you want to become a Medicare provider. Shaded Portion: Enter the taxonomy code. Taxonomy number: Code identifying a provider type and specialty OVERVIEW OF CLAIM FORM CHANGES Pending NPI implementation, continue to bill using your Medicaid Provider Number. Applied Behavioral Analysis (ABA) providers must use taxonomy number 103K00000X for billing ABA therapy services to ensure claims are paid appropriately. &
||AO=G]?Q t3/w 4pFsZN.m1F]jh;x6>nsI*nPhu;uL[JiukXw*vEs\)RVAJR(A\GclcX.prJV|PN6Z|rS']6f&h[a6sv},Y2VE{osDi 7;G~>btU:Gtivik-'&iAk/h"3Z 24.b. Insured person DOB and SEX of other payer in Insurance Information screen under Patient Master. Taxonomy codes are administrative codes set for identifying the provider type and area of specialization for health care providers. This code will be required when applying for a National Provider Identifier, also known as an NPI. Taxonomy codes are classified into three levels: provider type (Level I), classification (Level II), and area of specialization (Level III). 4 21 PLEASE PRINT OR TYPE APPROVED OMB-0938-1197 FORM 1500 (02-12) Circled items are new or have changed since 08/05 version. The revenue codes and UB-04 codes are the IP of the American Hospital Association. Patient MARITAL STATUS, EMPLOYMENT STATUS & STUDENT STATUS from Patient Master. To default to COS 030, HFS will use current default logic. 2023 FreePT - Physical Therapy EMR & Billing Software. means youve safely connected to the .gov website. You are using an out of date browser. Name of the INSURED PERSON of the destination payer in Insurance Information screen under Patient Master. This table reflects Medicare Specialty Codes as of April 1, 2003. CMS-1500 Claim Form UB-04 Form Locator; Billing Provider Taxonomy Code - required on all claims: 2000A, PRV03: Box 33b w/ ZZ qualifier preceding the taxonomy code: Box 81cc A w/ B3 qualifier: Rendering Provider Taxonomy Code - required on Professional claims when Rendering Provider information is submitted at the claim and/or service line . 315 0 obj
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taxonomy code if the NPI is entered in locator 33a open line. A Type 2 NPI is an entity/organization NPI. %PDF-1.6
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APPROVED OMB-093B-1197 FORM CMS-1500 (06-15) OMB No. Display Y if EMERGENCY check box is selected under Others tab in Charge Entry. 24.j. 261QD0000X Dental. REF. You must select the Qualifier for Taxonomy and enter the code: This is how it will display on your claim form: You must select the Qualifier for Taxonomy and enter the code. 24.e. You must log in or register to reply here. 277 0 obj
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3. Taxonomy code is constructed of 10 digits- numeric and alpha: (see example 1) Placement of Taxonomy and Qualifier Tips: Qualifiers are to be included on both paper and electronic claims for proper submission of claims Provider should be billing with the taxonomy that is filled with DCH Get Medicare billing update instantly 81b with B3 qualifier. hb```b``fe`a``cg@ ~r``xJwEC0H >(f`gcieMmu Finding Medicare fee schedule HOw to Guide, Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee, LCD and procedure to diagnosis lookup How to Guide, Medicare claim address, phone numbers, payor id revised list, Medicare Fee for Office Visit CPT Codes CPT Code 99213, 99214, 99203. INSURED'S ID NUMBER . Patient RELATION TO INSURED of destination payer in Insurance Information screen under Patient Master. For paper CMS-1500 professional claims, the taxonomy code should be identified with the qualifier "ZZ" in the shaded portion of box 24i. *PHP may be updating their denial/rejection code description. Claims and Billing Manual Page 5 of 18 Recommended Fields for the CMS-1450 (UB-04) Form - Institutional Claims (continued) Field Box title Description 10 BIRTH DATE Member's date of birth in MM/DD/YY format 11 SEX Member's gender; enter "M" for male and "F" for female 12 ADMISSION DATE Member's admission date to the facility in MM/DD/YY BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED, Missing/incomplete/invalid billing provider taxonomy, Missing/incomplete/invalid rendering provider taxonomy, Missing/incomplete/invalid attending provider taxonomy, Missing/incomplete/invalid rendering provider name, Submitted billing provider NPI is not registered with submitted Taxonomy, Rendering provider NPI Taxonomy is missing, Submitted rendering provider NPI is not registered with submitted Taxonomy. %%EOF
Usage: This code requires use of an Entity Code. . Other physician Taxonomy codes, including pediatric codes, may also be used. a) If Primary LE organization type is SOLO, it will show the Rendering Provider Name & Address. Please compare the information submitted to the information registered with the state of North Carolina. Share sensitive information only on official, secure websites. %PDF-1.6
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32 Displays the SERVICE LOCATION details selected in this claim. lock NPI is always required when submitting taxonomy on claim or line level. CPT 91311, 0111A, 0112A Covid Vaccine for children, 5 Important points to improve claim submission success rate. All Rights Reserved to AMA. Per the California Official Medical Fee Schedule (OMFS) the reimbursement amounts for treatment can differ based on the provider's Taxonomy Codes. 8. PAYER TYPE of the destination payer. Shows the CHARGE amount for each CPTs as entered in the Charge Entry/Charge Master. A taxonomy code describes the Provider or Organization's type, classification, and area of specialization. For a better experience, please enable JavaScript in your browser before proceeding. <>
Yes, if you want to become a Medicare provider. 24.a. 18 Display the ADMISSION DATE FROM & TO from Main tab in Charge Entry/Charge Master. This code list is a National Uniform Claim Committee (NUCC) property. An outpatient entity, facility, or distinct part of a facility within or affiliated with a Critical Access Hospital that provides access to primary care services for individuals in a small rural community and is Medicare certified. Display the NDC code Details for J codes on the top colored area above the CPT code. Enter the qualifier "ZZ" followed by the 10-digit taxonomy code. EMPLOYER name of the other payer insured person in Insurance Information screen under Patient Master. WPC Health Care Provider Taxonomy Code Set, Webinar: California Workers Compensation: Master the Original Bill. Always include billing provider taxonomy code. Attending Provider Taxonomy Code. 3) If Separate Account in LE is NO, it will show the Primary Legal Entity Name & Address. For the CMS-1500 version 02/12, the Taxonomy code associated to the Rendering Provider billed in Box 31 is placed within Box 24J (shaded) for each line billed on the claim. Enter the clinician's NPI in the NPPES NPI Registry. Hands down the best way to quickly determine up-to-date reimbursements and past dates of service. <>
Taxonomy codes are administrative codes set for identifying the provider type and area of specialization for health care providers. The taxonomy code is designated by the provider in order to identify his or her provider type, classification and/or area of specialization. 23 Display AUTH# selected in the Charge Entry/Charge Master under Main tab. . Their work resulted in a single taxonomy code set that both CMS and members of X12N found meaningful, easy to use, and functional for electronic transactions. Insured person EMPLOYER name of destination payer. It may not display this or other websites correctly. http://www.wpc-edi.com/products/codelists/alertservice. Enter the . If you are a behavioral health facility that bills Anthem at the organizational level on the CMS 1500, report the following taxonomy codes in the Billing Taxonomy field on the CMS-1500 (paper - field 33b, electronic - Loop 2000A/Segment PRV - field . Behavioral health facilities. 261QC1800X Corporate Health. Peach State Health Plan will reject the claim if the taxonomy codeis incorrect or omitted from the claim. To do this: 2000A PRV01, 02, 03. 24.c. For more information on filing compliant CMS-1500 Forms, please review DaisyBills California Billing Guide. Include if attending provider differs from 2000A PRV01, 02, 03. Providers must supply a valid NUCC taxonomy code when they apply for a National Provider Identifier (NPI). The Purpose of, Read More What is the taxonomy code for a home health agency?Continue, 2023 NPI Lookup Service - WordPress Theme by Kadence WP. . The Healthcare Provider Taxonomy code set is an external, nonmedical data code set designed for use in an electronic environment, specifically within the ASC X12N Healthcare transactions. hbbd``b`z"Dc,$aqDtLKWH[80W-L,F?? Insurance Claims & Payer Specific Requirements. All Rights Reserved to AMA. %
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When billing with a Type 2 NPI the entity's billing taxonomy code is required. ACCIDENT information in Charge Entry/Charge Master under Others tab. lock https:// For paper CMS-1500 professional statements, the taxonomy code should be marked with the qualifier ZZ in the shaded portion of box 24i. What is the taxonomy code for a home health agency? CMS Forms; Home; Healthcare Lookup Services; Taxonomy Codes Lookup; 367500000X; 367500000X Taxonomy Code Nurse Anesthetist, Certified Registered . Taxonomy codes must be included when submitting claims to prepaid health plans This is a reminder to providers that taxonomy codes must be included when submitting claims to prepaid health plans (PHPs), whether the claim comes from the individual provider or through a clearinghouse. Note: You may select more than one code or code description when applying for an NPI, but you must indicate one of them as the primary code. If this is your first visit, be sure to check out the. An official website of the State of North Carolina, Claims Denied Taxonomy Codes Missing, Incorrect, or Inactive, Taxonomy does not exist for Billing Provider. BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED, ACK/REJECT MISS INFO Entitys specialty/taxonomy code. Below are the procedure code modifiers that must be billed as the primary modifier by the facility/provider that performed the service, if Secure websites use HTTPS certificates. The CMS-1450 (UB-04) form is the industry standard for submitting institutional claims for inpatient and outpatient services. 24.i. The top shaded portion is the location for the reporting supplemental information. ) ?]wo~?/93~x@s?J GW/-o}K3.TlAzu/^:}WW7_c`>Aq?>?=7.O{j-9=iWW/ern7/^wnvm)xssq)5 ( Electronic claims are processed an average of 14 days faster than paper claims. Study with Quizlet and memorize flashcards containing terms like A HIPAA mandated electronic transaction for claims may also be called, What organization determines the content of both HIPAA 837 and CMS 1500 claims?, You need to send a claim to a payer who does not accept electronic claims.Identify the claim form you would use to send a paper claim. Follow the steps described below:-. Shows the DIAGNOSIS POINTER against each CPT as entered in Charge Entry/Charge Master. If you have a Payer requirement to display a Taxonomy code on your HCFA claims form, this will normally display in either HCFA Box 24j or Box 33b. 4. 33.a. View the entire data set at data.cms.gov, where you can choose from a variety of download formats to see the entire list. <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 12 0 R 20 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
Displays 2 character SECONDARY ID TYPE Qualifier & SECONDARY ID for the rendering provider against the billed insurance entered in Setup Insurance page under Provider Master. CMS has created a crosswalk of taxonomy codes that links the types of providers and suppliers who are eligible to apply for enrollment in the Medicare program with the appropriate Healthcare Provider Taxonomy Codes. 24j. 2310A PRV01, 02, 03. PLEASE NOTE: A system enhancement was configured on December 12, 2014 to allow claims to process accordingly for any that may have rejected when billed with the following requirements. PATIENT ADDRESS, CITY, STATE, ZIP CODE & HOME PHONE from Patient Master. CMS systems will accept roster bills for 1 or more patients that get the same type of shot on the same date of service. Box 24G requires a unit of at least "1." Key fields for proper paper claims submission The following key fields must be entered correctly on the CMS-1500 (02/12) claim form to ensure timely and accurate I have Medicaid denials due to the taxonomy code being improper/missing from the CMS1500 electronic form. Patient INSURED # of the destination payer in the Insurance Information screen under Patient Master. Each taxonomy code is a unique ten . Taxonomy codes are assigned to both individual and organizational providers. Shows CPT codes & MODIFIERS entered in the Charge Entry/Charge Master. Billing provider Taxonomy Code is missing. 21 Display first 4 DIAGNOSIS from the Charge Entry/Charge Master screen. (CMS) MLN Matters SE20011 provides more information on the use of Condition Code DR and Modifier CR for COVID-19 related Medicare claims. 25 Display the FEDERAL TAX ID or SSN according to rules below. . 17 Name of REFERRING PROVIDER from Charge Entry/Charge Master. Name of the DESTINATION PAYER. When Using the CMS-1500 Form When completing professional claims form (CMS-1500), please note the following: Field 24J (Rendering Provider ID #): This field is mandatory and should include the appropriate taxonomy code* for the provider rendering care. To give you a much clearer idea, let us first talk about the general structure that all the Taxonomy codes follow. 24.d. This code is used to denote that the provider has an NPI . Usage: This code requires use of an Entity Code. Usage: This code requires use of an Entity Code, ACK/REJECT MISS INFO Entitys specialty/taxonomy code. Both the billing provider and the attending/rendering provider should include their own taxonomy codes on the claim. Required when applicable and for any waiver-related services. Scenario One: Rendering NPI is different than the Billing NPI CMS 1500 Form Required Data . Shows the UNITS against each CPT entered in Charge Entry/Charge Master. b) If Primary LE organization type is NOT SOLO and, 1) If Separate Account in LE is YES and organization type is NOT SOLO, it will show the NPI# of Legal Entity. %PDF-1.5
The lower portion of the CMS 1500 claim form ( item numbers 14-33 ) : Electronic Claims & Office Ally Clearinghouse. To find the taxonomy code that most closely describes your provider type, classification, or specialization, use the National Uniform Claim Committee (NUCC) code set list. Secure .gov websites use HTTPSA The taxonomy code is 1041C0700X. You will use this code when applying for a National Provider Identifier, commonly referred to as an NPI. 24.h. 10.d.
SECONDARY ID for the rendering provider against the billed insurance entered in Setup Insurance page under Provider Master. If all the 3 are entered it will take ONSET OF CURRENT ILLNESS. ZZ and PXC are the qualifiers that apply to the provider taxonomy code. When submitting claims to PHPs, please continue to submit the appropriate billing provider taxonomy which is expected to be consistent with the taxonomy on your NCTracks provider record and valid for the service rendered. 682. To validate your taxonomy code, please use the NCTracks How to view and update Taxonomy on the Provider Profile in NCTracks User Guide. b) If Primary LE organization type is NOT SOLO and, 1) If Separate Account in LE is YES and organization type is NOT SOLO, it will show the Legal Entity Name & Address. the NPI and taxonomy code in 24J. 363A00000X. Taxonomy Code (CMS 1500) - administrative code set used to report a physicians specialty. (Required if applicable.) Select the referring doctor from the Select Referring Dr. drop-down menu. 19 field from Others tab in Charge Entry/Charge Master. For claims that have been submitted to PHPs and denied for invalid billing, rendering, or attending provider taxonomy codes, please immediately resubmit the denied claims with the corrected data. 2 0 obj
Online Provider Taxonomy code lookup. Billing - What is the taxonomy code for clinical social workers, which is required to get an NPI? 11 GROUP # of destination payer.
Taxonomy code searches are assigned at both the individual provider and organizational provider level. 2) If Separate Account in LE is YES and organization type is SOLO, it will show the value from Rendering Provider. Paper claims submitted via mail are processed an average of 12 days faster than paper claims submitted by fax. endobj
All PHP systems require taxonomy codes to be submitted on all claim types except pharmacy point of sale claims. The code-code field of the UB04 can be used to communicate the Now the dust has settled, learn about the greatest impacts as a result of the CMS 2023 Final Rule. As the name itself suggests, this one is the level of specialization as it provides the specific categories of Taxonomy codes. technologists or . Sign up to get the latest information about your choice of CMS topics. 81a with B3 qualifier. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. The code set is published and released twice a year, in January and July. Taxonomy codes will be required when submitting professional claims for all HAP and HAP Empowered business lines beginning January 1, 2020. 2) If Separate Account in LE is YES and organization type is SOLO, it will show the NPI# of Rendering Provider. CMS 1500 (02/12) CLAIM FORM INSTRUCTIONS . 22 Display corresponding codes for selected value from MEDICAID RESUB. 10d field under Others tab in Charge Entry/Charge Master screen. Box 33b is used to indicate a payer-assigned identifier of the Billing Provider. Here's how you know Enter appropriate ICD diagnosis codes horizontally in alpha order, 1 0 obj
2. To become a Medicare provider and file Medicare claims, you must first enroll in the Medicare program. Type the taxonomy code in the Facility ID (32b) text box. A providers taxonomy code can easily be found on the. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Medicare Enrollment Assistance & Contacts, National Plan & Provider Enumeration System, or NPPES, View the complete data set on data.cms.gov, National Uniform Claim Committee (NUCC) code set list. unshaded area. Provider Taxonomy (The qualifier in the 5010A1 for Provider Taxonomy is PXC, but ZZ will remain the qualifier for the 1500 Claim Form.) This code will be required when applying for a National Provider Identifier, also known as an NPI. 11.c. 9.a. Insured person DOB and SEX of destination payer. You must also check to the indicated below: * This requirement is normally payer specific and you should verify with individual payers as to the exact requirements prior to customizing these settings. Specialist. The following PHP denial/rejection codes may indicate claims have missing/invalid taxonomy codes: Attending not enrolled in Medicaid Program*, Billing Prov not enrolled in Medicaid Program*, Rendering Prov not enrolled in Medicaid Program*, ACK/REJECT INVAL INFO Payer Assigned Claim Control Number INVALID PAYER CLAIM CONTROL NUMBER SUBMITTED BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED ACK/REJECT MISS INFO Entitys specialty/taxonomy code. Taxonomy Code(s) Billing Loop (2000A), PRV segments - PRV02 = PXC PRV03 = taxonomy code. 7/1/2022. CMS 1500 Claim Form When submitting claims on the CMS 1500 form, please use the following guidelines for . Please compare the information submitted to the information registered with information registered with the state of North Carolina. Claim processing only accepts a set number of alphabet characters or digits for your code. Each year the Centers for Medicare and Medicaid Services (CMS) rolls out the proverbial carpet and ushers in new rules on regulatory compliance, coding and reimbursement. CODE & MEDICAID ORIG. Box 24I (shaded) must include a PXC or ZZ qualifier code for each line that is billed. Location Number (This qualifier is used for Supervising Provider only.) Enter the taxonomy code found in the NPPES NPI Registry. FIELD NUMBE R FIELD NAME INSTRUCTIONS 1 a . View the complete data set on data.cms.gov, where you can select various download formats to view the entire list. A providers taxonomy code can easily be found on the National Plan & Provider Enumeration System (NPPES) website. You can find a full list of taxonomy codes on the Washington Publishing Company (WPC) website in the Health Insurance Portability and Accountability Act (HIPAA) related code list section, at http://www.wpc-edi.com/products/codelists/alertservice. Field 57: Include the appropriate taxonomy code for all lines of business. Where does the NPI belong on the CMS-1500? Enter your NPI Number into the field, and then click Search. Display 2 character SECONDARY ID TYPE Qualifier for the rendering provider against the billed insurance entered in Setup Insurance page under Provider Master.