guides:claim-rules:taxonomy-code-override
Table of Contents
Taxonomy Code Override
Override the provider taxonomy code on claims. Can apply to the billing provider, rendering provider, or both.
Applies to: Professional (837P), Institutional (837I), Dental (837D)
When to Use This
- A multi-specialty provider needs different taxonomy codes per payer
- A payer rejects claims because the taxonomy doesn't match their records
- You need to override the billing taxonomy without changing the rendering taxonomy (or vice versa)
- A specific provider's claims always need a particular taxonomy code
Fields
| Field | Required | Description |
|---|---|---|
| Start Date | Yes | When this rule becomes active |
| End Date | No | When this rule expires |
| Payer Number | No | Only apply for a specific payer. Blank = all payers |
| Provider NPI | No | Only apply when this NPI is found on the claim (checks both billing and rendering). Blank = apply regardless of provider |
| New Taxonomy Code | Yes | The taxonomy code to set (e.g., “207Q00000X”) |
| Override Billing Taxonomy | No | Check to update the billing provider's taxonomy in Loop 2000A |
| Override Rendering Taxonomy | No | Check to update the rendering provider's taxonomy in Loop 2310B |
| Notes | No | Your reference notes |
Note: Check at least one of “Override Billing Taxonomy” or “Override Rendering Taxonomy” — otherwise nothing will change.
Examples
Example 1: Override Billing Taxonomy for Medicare
Medicare requires taxonomy “207Q00000X” (Family Medicine) for the billing provider.
| Field | Value |
|---|---|
| Payer Number | 00882 |
| New Taxonomy Code | 207Q00000X |
| Override Billing Taxonomy | ✓ Checked |
| Override Rendering Taxonomy | Not checked |
Example 2: Override Both for Specific Provider
Dr. Smith's claims to Aetna need taxonomy “2084P0800X” (Psychiatry) on both billing and rendering.
| Field | Value |
|---|---|
| Payer Number | 60054 |
| Provider NPI | 1234567890 |
| New Taxonomy Code | 2084P0800X |
| Override Billing Taxonomy | ✓ Checked |
| Override Rendering Taxonomy | ✓ Checked |
What Happens on the Claim
- If Override Billing Taxonomy is checked: updates PRV segment element 3 in Loop 2000A
- If Override Rendering Taxonomy is checked: updates PRV segment element 3 in Loop 2310B (inside Loop 2300)
- If Provider NPI is set: first checks that the NPI appears on either the billing or rendering provider before applying
- A note is added documenting the change
- Shows in Applied Validation Modules as “TaxonomyCodeOverrideModule”
guides/claim-rules/taxonomy-code-override.txt · Last modified: by brad.sharp