Follow-up on Billing Provider Taxonomy Claims Requirement Effective September 1, 2018

Clearing House Process Verification: Please verify with your clearing house that the TMHP attested billing provider taxonomy is being transmitted on claims for all products. Through collaborative work with provider groups, it has been identified that some clearing houses have been removing the billing taxonomy code on claims prior to submitting to the health plan for processing resulting in claims denials. Billing provider taxonomy is a requirement effective 9/1/2018. Because providers use a variety of clearing houses for claims submission, your clearing house may already be working to resolve the problem. Please check with them for the latest status. Correct Billing Taxonomy Code Placement: For electronic claims: loop and segment 2000A, PRV03. Electronic resubmission options: Impacted providers must submit corrected claims for reprocessing. In the interim, while waiting for your clearing house to resolve the issue, Providers have three choices on how they can file the claim to be processed for payment for the taxonomy code issue:

1. File batched claims thru Texas Children’s Health Plan portal.
2. File claims thru Texas Medicaid Healthcare Partnership (TMHP) portal if allowed to submit this way.
3. Ensure the clearing house has corrected this issue for claims processing and resubmit corrected claims impacted.

If you have any questions please email Provider Network Management at providerrelations@texaschildrens.org. For more information:TMHP - Claims FilingTMHP - Provider Enrollment - Texas Medicaid - New Providers