Taxonomy Code Requested on Claim Submissions

Feb 12, 2024

The Office of MaineCare Services (OMS) is requesting that providers include the taxonomy code on all claims. The taxonomy code is necessary for the Centers for Medicaid and Medicare Services (CMS) to collect data for Transformed Medicaid Statistical Information System (T-MSIS) reporting. This data helps to inform states of their current standing in data quality as compared to other states and is crucial for research and policy on Medicaid and CHIP and helping the Centers for Medicare & Medicaid Services (CMS) conduct program oversight, administration, and integrity.  

The taxonomy code can be reported on each claim in the following fields for each type of submission:   

Electronic Claim Submissions: 

837P - CMS 1500 

Rendering provider – Loop 2310B Segment PRV03.  Billing provider - Loop 2000A Segment PRV03.  

837I - UB04 claim 

Billing provider - Loop 2000A Segment PRV03.  

837D – Dental 

Rendering provider – Loop 2310B Segment PRV03.  Treating provider - Loop 2000A Segment PRV03. 

Paper Claim Submissions: 

CMS 1500 

The billing and/or rendering provider taxonomy will be captured. 

Rendering Provider        Box 19  

•    Qualifier ZZ  •    Taxonomy codes reported in this field must not be reportable in other fields, i.e., Item Numbers 17, 24J, 32, or 33.   •    When reporting a second item of data, enter three blank spaces and then the next qualifier and number/code/information.  

        OR 

      Box 24J - In the shaded portion  

Billing Provider        BOX 33B 

• Place the taxonomy code in box 33B proceeded with the ZZ qualifier for the billing level  

UB04 

Billing Provider      Form Locator 81 

•    Qualifier “B3”  •    taxonomy code 

Dental 

ADA Dental Claims - Treating Dentist  

• Box 56A Provider Specialty Code (Taxonomy) 

PORTAL 

Note that claims will not submit until a provider taxonomy code is entered on the claim in the appropriate field. 

CMS 1500 

Enter the code in the field that states “Enter a billing or rendering provider taxonomy code”  

UB04 claim 

Enter the code in the field that states “Enter a billing provider taxonomy code” 

Dental 

Enter the code in the field that states “Enter the treating provider taxonomy code” 

​​If you have any questions, please contact Provider Services at: 1-866-690-5585.​