Claim Denied: Could It Be Due To The Taxonomy Code?
We've all experienced the frustration of not receiving payment or reimbursement on a claim we've submitted. It's especially annoying when you know that your submittal is legitimate and it was costly. It's even more so when your claim is turned down because the payer doesn't consider it legitimate when you know that it is. There are many reasons why claims are refused besides not being within your coverage range. Some are complicated, some are as simply as typography.
Why Would Your Claim Be Denied?
The AMA recently contacted its network to caution both physicians and vendors that using lower case letters in their medical billing Taxonomy Code (CODE) could be a reason that there have been some claims denied. There are many other typo-related reasons for claims denial. They include: Name spelled incorrectly, birthdate doesn't match, insured group or subscriber number are missing or wrong. All simple errors to make that could delay your payment for weeks. Then there's the taxonomy code.
Taxonomy Code? What's That?
Taxonomy means "names for stuff". The Taxonomy Code is a patented list of ten numbers representing external codes for medical services developed by the National Uniform Claim Committee (NUCC). NUCC is a volunteer group whose members come together to create a data set for use by the non-instituional healthcare community to communicate claims and related information to all third-party payers. The committee is composed of a interdisciplinary group of industry professionals including payers, providers, vendors, public health organizations and designated standards maintenance organizations. The American Medical Association (AMA) chairs the group along with their partner the Center for Medicaid and Medicare Services (CMS).
NUCC and the American National Standards Institute (ANSI) should work in conjunction to adhere to the Taxonomy Code as developed by NUCC which is the authoratative voice for national standard content definitions for non-institutional health care claims in the US. NUCC's suggested code is supposed to compliment and enhance the ASC X12N claims list.
Important to Verify All Codes
It is imporatant that all vendors verify that the code they receive with ASC X12N claims is compatable with the NUCC Taxonomy Code. For example, the Taxonomy Code does not allow for lower case letters. The code is comprise of upper case and numeric figures. Inserting a lower case letter in claims code will cause the claim to be delayed and possibly completely denied. Careful consideration is needed to make sure that electronic data interchange (EDI) that was developed by ANSI is clearly in sink with the NUCC Taxonomy Code for the sake of everyone in the claims process from payee to payer and all points inbetween.
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