May the Billing Provider Loop for the X12 837P be used to report a provider Taxonomy Code for a non-individual provider when the usage notes in the adopted Version of the Implementation Guide requires reporting only in certain situations?
The Healthcare Provider Taxonomy Code (HPTC) that is permitted for certain situations in the 4010/4010A1 837P Implementation Guide is a 10-character alphanumeric administrative code that identifies the health care provider type, classification, and, for some classifications, the area of specialization of health care providers. The code set is maintained and updated by the National Uniform Claim Committee (NUCC). Health care providers may have more than one HPTC depending on their classifications and specializations, and select their own HPTCs from a list of available codes that is published by the Washington Publishing Company (available at www.wpc-edi.com/taxonomy.) While HPTCs are not health care provider identifiers, they do identify provider type, classification, and/or specialization, which is information that is often needed by health plans to determine claim reimbursement and subscriber benefits. The Version 4010/4010A1 of the 837P Implementation Guide (for professional claims)
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