Identifying your taxonomy code for claims

A taxonomy code identifies a provider’s specialty on insurance claims. In this guide, we'll cover:

• Finding your taxonomy code
• Entering your taxonomy code for claims
• Default taxonomy codes
• Resolving a rejected claim due to a missing or invalid taxonomy code in box 24j
• Troubleshooting taxonomy codes

Finding your taxonomy code

Certain payers require the rendering provider’s taxonomy code listed in box 24j of claim submissions. If a payer requires this, they’ll also require the ZZ qualifier listed in box 24i.

Since the requirements for these fields vary by payer, the ZZ qualifier would be enabled from our administrative backend. Once it’s enabled, the taxonomy code will populate all claims created for the specific payer ID that requires it.

The ZZ qualifier (box 24i) and the rendering provider’s taxonomy code (box 24j) won’t appear on an electronic claim. However, this information is sent to the insurance payer through the electronic claim’s backend.

If you’d like to review the information that gets sent to the payer, you can download the PDF version of the claim. Here’s what this section looks like on a downloaded claim:

If the information appears on a downloaded claim, then it’s being sent to the payer electronically.

If a downloaded claim for a payer that requires a taxonomy code and ZZ qualifier doesn’t appear with these items in box 24, submit a help request to our team. We can work with our clearinghouse to verify the requirement and make any necessary updates to the settings from our end.

To find your taxonomy code:

1. Visit the NPPES NPI Registry
2. Enter your NPI Number into the field
3. Click Search

Entering your taxonomy code for claims

Typically, a claim will need to reflect the taxonomy code associated with your billing provider NPI in box 33b, which may either be an individual or organizational NPI. Certain payers may also require the taxonomy code associated with your rendering provider NPI in box 24j, which would be your individual NPI.

Entering the taxonomy code for your billing provider NPI

To enter the taxonomy code associated with your billing provider NPI:

1. Navigate to Settings > Client billing and insurance > Insurance billing
2. Select Edit next to your default Billing provider info

3. Search for the Taxonomy Code associated with your individual NPI

4. Click Save profile

Note: Billing profiles can be used to populate unique information for certain payers and/or clinicians in boxes 25 and 33, including taxonomy codes. For more information, see Managing billing profiles for insurance.

Entering the taxonomy code for your rendering provider NPI

To enter the taxonomy code associated with your rendering provider NPI:

1. Navigate to Settings > Profile > Clinical info 
2. Select Edit next to your Clinician details

3. Search for the Taxonomy code associated with your individual NPI

4. Click Save

Our system will automatically populate the taxonomy code you enter in the above section into box 24j for payers that require it. However, because the rendering provider taxonomy code isn’t required by all payers, it’s not visible unless you download the claim form.

Note: If you’re billing under your supervisor's credentials, your clinical information may need to be adjusted depending on the payer’s requirements. For more information, see Billing insurance under supervision. 

Default taxonomy codes

The Account Owner’s rendering provider taxonomy code and practice taxonomy code will default to the specialty they select when creating their account.

A new team member’s rendering provider taxonomy code will default to the specialty the Account Owner selects when adding them.

Note: Only the clinician will be able to update their rendering taxonomy code. Account Owners don’t have access to make this change. 

Resolving a rejected claim due to a missing or invalid taxonomy code in box 24j

If you receive a claim rejection for a missing or invalid taxonomy code in box 24j, the rendering clinician will first want to check in their account settings to make sure that the correct taxonomy code is entered in the appropriate field.

Note: If you're part of a group practice, only the individual clinician can update their taxonomy code within their Clinical info settings.

To do this, the rendering clinician can:

1. Visit the NPPES NPI Registry
2. Enter their NPI in the field
3. Click Search
4. Copy the taxonomy code
5. Navigate to Settings > Profile > Clinical info
6. Select Edit next to their Clinician details
7. Enter the Taxonomy Code

8. Click Save

Next, you'll need to delete the existing claim and create a new claim to have the updated settings auto-populate. To do this:

1. Navigate to Insurance > Claims
2. Select View next to the rejected claim
3. Click the trash icon to delete the claim

Important: Deleting claims is a permanent action. When claims are deleted, all information listed in them is deleted from our database and can't be recovered. To keep this information for your records, we recommend downloading and saving a claim to a client's profile before deleting it. See Uploading a new client file for steps on how you can store this. When deleting a claim, it’s recommended that you save the Clearinghouse Reference Number and Payer Claim number for your records as well.

4. Navigate to Insurance > Unbilled appointments
   • Any dates of service that were on the deleted claim will now be free to include on a new claim
5. Create and submit the new claim

Tip: You can download the new claim before submitting it to confirm that the correct rendering provider taxonomy code is populated into box 24j.

If a claim is created before your taxonomy code is updated in your account settings, you'll need to recreate the claim in order for the changes to appear on the claim, even if it wasn't submitted.

Troubleshooting taxonomy codes

If your taxonomy codes aren’t populating on claims as expected, you can review the information your payers have on file and confirm this matches your settings. To do this:

• Confirm the billing provider taxonomy code and rendering provider taxonomy code your payers have on file
• Review your rendering provider taxonomy code at Settings > Profile > Clinical info
  • If part of a group practice, each team member should review their rendering taxonomy code
    • Account Owners can’t update a team member’s rendering taxonomy code
• If you’re a supervisee, check your payers’ requirements for submitting claims and review your settings to make sure they’re set up correctly
  • For more information, see Billing insurance under supervision 
• Review your practice’s billing provider taxonomy code at Settings > Client billing and insurance > Insurance billing
  • If using billing profiles, review the taxonomy codes in your billing profiles
    • For more information, see Managing billing profiles for insurance
• If you’re receiving a rejection related to the rendering taxonomy code in box 24j, see Resolving a rejected claim due to a missing or invalid taxonomy code in box 24j above