Provider claims submission must include the NPI and taxonomy code(s) that match the National Plan and Provider Enumeration System (NPPES) file for the date of service. Claims submitted without an NPI and taxonomy code(s) or with an NPI/taxonomy code(s) combination that does not match NPPES will be denied.
Provider Type Details:
- Billing providers are always required to submit TIN, NPI and taxonomy.
- Attending Providers are always required to submit NPI and taxonomy.
- Ordering, Referring and Prescribing physicians are not always required for billing on claims however, if submitted, they will undergo the NPI/taxonomy validation process described above.
NOTE: As of January 1, 2021, claims that do not comply with the above requirements will be denied.
