Handling Taxonomy on Crossover Claims — Medicare to Medicaid

The North Carolina Medical Society (NCMS) has heard there is confusion surrounding taxonomy numbers for claims when the claim “crosses over” to Medicaid after Medicare benefits/payment is applied. Palmetto GBA has provided information to clarify this issue.

Medicare does not require a taxonomy code to process a claim; however, Palmetto will verify that the taxonomy code is valid by comparing it with the latest National Uniform Claim Committee (NUCC) Healthcare Provider Taxonomy Codes (HPTC) code set if it is submitted on the claim. We would include the taxonomy code on any crossover to another insurance company. You may wish to check with your clearinghouse or billing company to ensure they are not stripping the taxonomy number from your claim prior to transmitting to Medicare.

To read Palmetto’s full explanation, click here.


Share this Post