TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > TMHP Electronic Claims Submission > Benefit and Taxonomy Codes


6.2.1 Benefit and Taxonomy Codes

Providers that submit electronic claims are required to submit new data fields. The Benefit Code field (when applicable), Address field, and Taxonomy Code field must be completed before submitting electronic claims.

Taxonomy codes do not affect pricing or the level of pricing, but rather are used to crosswalk the NPI to a TPI. It is critical that the taxonomy code selected as the primary or secondary taxonomy code during a providers enrollment with TMHP is included on all electronic transactions.

Group billing providers are not required to submit a taxonomy code on all electronic claims.

Billing providers that are not associated with a group are required to submitting a taxonomy code on all electronic claims. TMHP will reject claims for non-group billing providers (individuals and facilities) that are submitted without a taxonomy code.

Medicare does not require a taxonomy code for Part B claims. Therefore, some claims submitted to TMHP from Medicare for payment of coinsurance and deductible may not include the taxonomy code needed for accurate processing by TMHP.

Texas Medicaid & Healthcare Partnership
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