***Manually Adding provider taxonomy -- HIPAA Requirement***

This section will assist the user in adding HIPAA provider taxonomy
codes into the Resource Patient Management System (RPMS) for electronic
claims submission in the Third Party Billing system. The Third Party
Billing system utilizes these codes when sending an electronic 837 Claim
file to a payer and must be in place in order to send a successful file.

***Background***

Provider taxonomy codes are used in transactions as specified in the
Health Insurance Portability and Accountability Act (HIPAA). The
taxonomy codes were created to identify and code an external provider
table that would be able to standardize provider types and provider
areas of specialization for all medical related providers. CMS\' intent
was to provide a single coding structure to support work on the National
Provider System, while X12N needed a single common table for trading
partner use.

A companion document/taxonomy manual is available and may be obtained
from <http://www.wpc-edi.com/hipaa/HIPAA_40.asp>. This document provides
a listing of taxonomies and their code structures and is recommended to
have while entering these codes into RPMS. Link to the [WPC
website](http://www.wpc-edi.com/codes/)
(<http://www.wpc-edi.com/codes/>) to obtain the most recent copy of the
Provider Taxonomy file.

***Code Structure***

The Provider Taxonomy is a unique alphanumeric code, ten characters in
length. The code list is structured into three distinct levels including
Provider Type, Classification, and Area of Specialization as described
below.

> **Level I, Provider Type**: a major grouping of service(s) or
> occupation(s) of health care providers. For example: Allopathic &
> Osteopathic Physicians, Dental Providers, Hospitals, etc.\
> \
> **Level II, Classification**: a more specific service or occupation
> related to the Provider Type. For example, the Classification for
> Allopathic & Osteopathic Physicians is based upon the General
> Specialty Certificates as issued by the appropriate national boards.
> The following boards will however, have their general certificates
> appear as Level III areas of specialization strictly due to display
> limitations of the code set: Medical Genetics, Preventive Medicine,
> Psychiatry & Neurology, Radiology, Surgery, Otolaryngology,
> Pathology.\
> \
> **Level III, Area of Specialization**: a more specialized area of the
> Classification in which a provider chooses to practice or make
> services available. For example, the Area of Specialization for
> provider type Allopathic & Osteopathic Physicians is based upon the
> Subspecialty Certificates as issued by the appropriate national
> boards.

The Provider Taxonomy Code List allows a single provider (individual,
group, or institution) to identify their specialty category. Taxonomy
codes are divided into two different groups:

> **Individual or group codes -** classify the type of provider or group
> using the different level codes. The following displays an entry from
> the Provider Taxonomy manual:
>
> Note that when you enter the provider taxonomy into RPMS, it is
> helpful to enter the Level II description. For example, if the
> provider is an Emergency Room Physician, you may enter **'Emergency'**
> into RPMS and the system will display the following:
>
> The system is case-sensitive when entering the provider taxonomy.
> Please make sure the provider name is being entered correctly with
> *[lowercase letters]{.underline}*. For more specific categories, such
> as SPORTS MEDICINE, the user can enter 'Sports' and the system will
> attempt to locate all Sports Medicine providers.
>
> **Non-Individual taxonomies** -- provide a classification for
> healthcare facilities, agencies, nursing units and suppliers and
> various vendors. These codes are categorized the same way the
> Individual or Group codes are classified using the same Level I
> through Level III codes.
>
> **\
> **The following provides a sample of a Non-Individual taxonomy:

The taxonomy codes are published twice a year on July 1^st^ (which
become effective October 1) and January 1^st^ (which become effective
April 1^st^). ITSC will provide the updates to be installed into RPMS
under the AUT namespace. This means that the Taxonomy updates will be
maintained separately.

***Adding Taxonomies to RPMS***

Taxonomies can be added into RPMS using VA Fileman and the User
Management options in the Kernel Menu. If you do not have access to
these options, you may have to have your site manager help you.

***Individual or Groups***

Individual or group codes are set up individually by provider and would
need to be set up for all billable providers. This is will have to be
set up in VA FileMan. It's recommended to start out by inputting your
most common providers. This also affects the secondary providers (i.e.
RN's, Pharmacists, etc.) that your facilities may have on a claim. Use
the following steps to add the provider taxonomy into the provider file:

1.  Access VA FileMan.

2.  Choose ENTER OR EDIT FILE ENTRIES and press \<return\>.

3.  The system will prompt for the following: "INPUT TO WHAT FILE:" Type
    **NEW PERSON** and press \<return\>.

4.  The system will prompt for "EDIT WHICH FIELD: ALL//". Type **PERSON
    CLASS** and press \<return\>.

5.  Thy system will prompt for "EDIT WHICH PERSON CLASS SUB-FIELD:
    ALL//". Press \<return\>.

6.  The system will then prompt for "THEN EDIT FIELD:". Press \<return\>
    at this prompt.

Select VA FileMan Option: ENTER or Edit File Entries

INPUT TO WHAT FILE: NEW PERSON// NEW PERSON (646 entries)

EDIT WHICH FIELD: ALL// PERSON CLASS (multiple)

EDIT WHICH PERSON CLASS SUB-FIELD: ALL//

THEN EDIT FIELD:

7.  The system will then prompt for the name of the provider. Enter the
    provider name using the format of Last name, First name. Press
    \<return\>.

Select NEW PERSON NAME: CURESME,THOMAS

8.  The system will then prompt for the user to enter the Person Class.
    The user will need to enter the appropriate taxonomy code for their
    provider.

9.  The system will prompt for an effective date. Enter the date the
    provider's credentials became effective. Press \<return\>.

10. The system will prompt for an expiration date. Leave this field
    blank unless the credentials expired for that provider. Press
    \<return\>.

11. Once the information has been entered, press \<return\> and the
    information will be stored. The user has the option to enter another
    provider taxonomy.

***Non-Individual***

Non-Individual codes are for your general location and would need to be
set up for all billing locations. This is set up in VA Fileman under the
Location File. Use the following steps to add the provider taxonomy into
the location file.

1.  Access VA FileMan.

2.  Choose ENTER OR EDIT FILE ENTRIES and press \<return\>.

3.  The system will prompt for the following: "INPUT TO WHAT FILE:" Type
    **LOCATION** and press \<return\>.

4.  The system will prompt for "EDIT WHICH FIELD: ALL//". Type **CLASS**
    and press \<return\>.

5.  The system will prompt for "EDIT WHICH CLASS SUB-FIELD: ALL//". Type
    **CLASS** and press \<return\>. This allows you to only edit the
    class field.

6.  The system will then prompt for "THEN EDIT CLASS SUB-FIELD:". Just
    hit \<return\> at this prompt.

Select option: ENTER OR EDIT FILE ENTRIES

INPUT TO WHAT FILE: LOCATION//

EDIT WHICH FIELD: ALL// **CLASS** (multiple) Type \'**CLASS**\' here

EDIT WHICH CLASS SUB-FIELD: ALL// **CLASS** Type \'**CLASS**\' here

THEN EDIT CLASS SUB-FIELD:

THEN EDIT FIELD:

7.  The system will then prompt the user for "Select LOCATION NAME:".
    Type the appropriate location name. If more than one location entry
    appears, the system will then display all available locations from
    the Location File. Choose your location if a list appears then press
    \<return\>.

8.  The system will prompt "Select BEGIN DATE: \<date\>". A date should
    already be established. DO NOT MODIFY THIS ENTRY. Press \<return\>
    to go to the next prompt.

9.  The system will prompt for "CLASS". You may use the [Health Care
    Provider Taxonomy]{.underline} manual provided on the WPC website or
    type in double question marks (??) to get a listing of the location
    taxonomy codes. Type in the appropriate class code that best defines
    your facility. Once entered, press \<return\>.

Select LOCATION NAME: **MAJOR MED C** AREANAME SERVICEUNIT 01 NM PHS

808401

\...OK? Yes// (Yes) Choose your location here

Select BEGIN DATE: JAN 1,1960// \<return\>

CLASS: Type in the classification of your facility

***Billing and the Claim Editor***

Once the provider and location taxonomy codes have been entered, they
may be used right away. The user will not see any of the codes in the
claim editor. They may access the Provider Inquiry (PRTM) option the
Table Maintenance to view these codes.

***Troubleshooting***

The following are some of the most common RPMS Third Party Billing
errors and how they can be corrected:

1.  Question #1

```{=html}
<!-- -->
```
q.  I am getting an error in the claim editor on Page 4 that displays
    "ERROR 191 -- MISSING PROVIDER TAXONOMY". How can I correct this?
    Should I be concerned?

```{=html}
<!-- -->
```
a.  This error occurs on the provider page in the claim editor and can
    be corrected by adding the provider taxonomy into the provider file.
    Also, if the mode of export is the 837, the system will do a check
    for the taxonomy code. If this is missing, then Error 191 will
    occur. Please follow the steps above to resolve this.

```{=html}
<!-- -->
```
2.  Question #2

    q.  When I am submitting my claims electronically, I am using the
        837 format. But when I am sending them, my batch gets rejected
        with an error code that states the 'PRV' segment is not
        populated. What does that mean.

    ```{=html}
    <!-- -->
    ```
    a.  This could mean that the taxonomy codes were not set up prior to
        creating the electronic batch. Add the taxonomy codes and
        re-create your file. Re-send the batch.

***Questions?***

***Contact: Adrian Lujan***

***Information Technology Support Center***

***(505) 248-4349***

[***adrian.lujan@mail.ihs.gov***](mailto:adrian.lujan@mail.ihs.gov)