Wiki ASC billing - Denied MCAR

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mcalonzo2000

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I'm new to ASC billing and we got a denial from MCAR with code CO-8 "The procedure code is inconsistent with the provider type/specialty (taxonomy). Note: Refer to the 835 Healthcare Policy Identification Segment. I tried researching & looking for the answer online but never got a direct answer for it. Does anyone know or any experience on this and how it can be solved?:confused:
 
mcalonzo2000 said:
I'm new to ASC billing and we got a denial from MCAR with code CO-8 "The procedure code is inconsistent with the provider type/specialty (taxonomy). Note: Refer to the 835 Healthcare Policy Identification Segment. I tried researching & looking for the answer online but never got a direct answer for it. Does anyone know or any experience on this and how it can be solved?:confused:
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This needs to go to whomever in your system set up the billing system. They need to check the provider taxonomy codes to see if that provider is correctly set up for the type of service that was being done. Every provider has a number of taxonomy codes to choose from for the types of service they perform. If the correct one is not registered, payment will be denied for certain types of care.

"What are the Healthcare Provider Taxonomy Codes (HPTC)?

Where may I obtain a copy of the codes?The Healthcare Provider Taxonomy Codes (HPTC) are a HIPAA standard code set named in the implementation specifications for some of the ASC X12 standard HIPAA transactions. The “Healthcare Provider Taxonomy Code” is a situational data element in the 4010 X12 Implementation Guides and the 5010 X12 TR3 Reports for the 837 Professional and Institutional. If the Taxonomy code is required in order to properly pay or process a claim/encounter information transaction, it is required to be reported. Thus, reporting of the Healthcare Provider Taxonomy Code varies from one health plan to another. The Healthcare Provider Taxonomy code set divides health care providers into hierarchical groupings by type, classification, and specialization, and assigns a code to each grouping. The Taxonomy consists of two parts: individuals (e.g., physicians) and non-individuals (e.g., ambulatory health care facilities). All codes are alphanumeric and are 10 positions in length. These codes are not “assigned” to health care providers; rather, health care providers select the taxonomy code(s) that most closely represents their education, license, or certification. If a health care provider has more than one taxonomy code associated with it, a health plan may prefer that the health care provider use one over another when submitting claims for certain services. The Healthcare Provider Taxonomy code set is available at no charge from the Washington Publishing Company's website: http://www.wpc-edi.com/codes/taxonomy The Healthcare Provider Taxonomy code set is maintained by the National Uniform Claim Committee (NUCC). The NUCC accepts requests for new codes and requests for changes to existing codes or descriptions. The criteria for review of a request for a new code or a change are available on the NUCC web site at: www.nucc.org The code set is updated twice a year. "
 
being the ASC, you may have a procedure that MCare has designated as not allowable in the ASC, in other words, acute care outpatient only. This could explain the mismatch between the procedure and the taxonomy for your ASC.
 
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