Document 6526580

To:
From:
Date:
RE:
CoventryCares of Kentucky Providers
CoventryCares of Kentucky Provider Relations
November 15, 2013
Taxonomy Number Edit Implementation by DMS
Last week we sent our provider partners information regarding the NPI and taxonomy edits that were
implemented by the Kentucky Department for Medicaid Services (DMS) on October 1, 2013.
In compliance with DMS’s notification, CoventryCares of Kentucky is implementing claims edits to
require the billing provider and rendering provider taxonomy numbers. Beginning November 24, 2013,
claims that do not have the billing and rendering provider NPI and taxonomy codes will be rejected.
Providers will have to resubmit any rejected claims with the required NPI and taxonomy codes. Claims
will continue to reject until the required information is submitted.
Since some providers may have multiple taxonomy codes, it is the provider’s responsibility to ensure
that the taxonomy codes associated with the billing provider and rendering provider are appropriate for
the type of service delivered on the date of service and at the location where the service was rendered.
You must also ensure that the NPI, taxonomy and address demographic information you have on file
with DMS matches what you have on file with CoventryCares of Kentucky.
DMS uses NPI, taxonomy number, and address demographics submitted on encounters for a number of
uses that affect providers directly. The uses include, but are not limited to, determining enhanced
payments for primary care services and vaccines under the Affordable Care Act and FQHC/RHC wraparound payments. In order for a provider to be properly paid, claims must include the billing and
rendering taxonomy codes.
In order to assist providers in understanding the edits being implemented, CoventryCares of Kentucky is
providing information about the submission of NPI and taxonomy information. We are also providing
information about error or “reject” messages you will receive if the required information is not
submitted on claims.
If you need assistance with this change, please contact your Provider Relations Representative by dialing
1-855-454-0061.
NPI and Taxonomy Submission Information
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CMS 1500 Paper Claims (professional)
o Billing Provider NPI submitted in box 33A
o Billing provider taxonomy submitted in box 33B - Enter the 2-digit qualifier of ZZ
followed by the taxonomy code. Do not enter a space, hyphen, or other separator
between the qualifier and number (e.g. ZZ207Q00000X)
o Rendering NPI in box 24J (bottom of box, non-shaded area)
o Rendering provider taxonomy submitted in box 24I and 24J (top of box, shaded area) –
Code ZZ must be submitted in box 24I and the taxonomy code submitted in 24J.
Note: ZZ qualifier is sent in a separate field and not included with the code in 24J.

UB-04 Paper Claims (institutional)
o Billing Provider NPI submitted in field 56, top row
o Billing provider taxonomy submitted in field 81 - Enter the 2-digit qualifier of B3 in the
first column and then the taxonomy code immediately following.

EDI Claims
Billing Provider (2010AA)
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National Provider ID (NPI) is required - CoventryCares expects that this NPI is typically a Type
2 (organizational provider) NPI. Individuals with a Type 1 NPI are only allowed to be sent as
the Billing Provider when services were performed by non-incorporated, independent,
individuals.
Billing Provider's Last Name (NM103) and First Name (NM104) are both required if the
provider entity type qualifier indicates "person." Provider first name should be submitted
completely and not just a first initial. However, CoventryCares expects this data to reflect
an organizational provider (entity type 1) and only be submitted with the last name
(NM103) in most cases.
Billing Address must be a street address and cannot contain P.O. Box or rural route address
information. P.O. Box address must be submitted in the Pay To Address loops.
Billing Zip Code must be a full 9 digit zip code.
Taxonomy (PRV) - required on all claims
Rendering Provider (2310B) *** Professional EDI Claims ***
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National Provider ID (NPI) is required for the rendering provider when rendering provider is
submitted.
Rendering Provider Name (Loop 2310B) is required when different than the billing provider
(2010AA). Provider first name should be submitted completely and not just a first initial.
If a NPI is submitted for the rendering provider, a taxonomy number must also be submitted
for the rendering provider.
If you submit rendering provider information at the claim header level (Loop 2310B), do not also submit
service line level (Loop 2420A) rendering provider information.
Coventry Cares of Kentucky Reject Messages

EDI Claims
When a rendering provider’s taxonomy code is missing from professional claims, a provider will
receive back through their clearinghouse a Payer/Level 2 Reject messages that states:
Rendering Taxonomy Missing/Invalid
When a billing provider’s taxonomy code is missing from institutional claims, a provider will
receive back through their clearinghouse a Payer/Level 2 Reject messages that states:
Billing Taxonomy Missing/Invalid

Paper Claims
When a rendering provider taxonomy is missing from paper professional claims, a letter will be
mailed to the provider stating rendering taxonomy missing/invalid.
When a billing provider taxonomy is missing from paper institutional claims, a letter will be
mailed to the provider stating billing taxonomy missing/invalid.
Again, if you need assistance with this change, please contact your Provider Relations Representative by
dialing 1-855-454-0061.
Thanks for your prompt attention to this matter.