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Last Modified: 9/29/2022 Location: FL, PR, USVI Business: Part B

Billing the taxonomy code

Are you submitting claims for COVID-19 testing, vaccine or monoclonal antibody (mAb) infusion administration and experiencing issues with your claims processing under the incorrect PTAN?
Medicare requires claims to contain NPIs to be accepted for adjudication. NPIs reported on the claims are cross walked to the Medicare assigned PTAN. Adjudication is based on a one-to-one match between the two. When a unique match cannot be made, your claim may be denied.
First Coast has seen an increase in claims being denied because eligible providers are requesting temporary enrollments to submit claims for COVID-19 testing, vaccine or mAb infusion administrations. If your claims are denied for this reason, we recommend you resubmit your claims using the taxonomy code to assist with assigning the correct PTAN.
Note: Centralized billers and mass immunizers do not have assigned taxonomy codes for their specialty types. It is best practice to verify the taxonomy code selected on NPPES. In addition, both specialties have been approved to use pharmacy taxonomy codes on their claims.

Additional information

Please visit First Coast’s Coronavirus (COVID-19) webpage for additional information.
For more details about the NPI-to-PTAN crosswalk, review the article Multiple PTAN matches to single NPI.
For more details about taxonomy codes, review the CMS Find Your Taxonomy Code external link webpage.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.