region/plan-specific news
: Commercial Health Plans in TX
Help make sure your Texas Medicaid claims get paid--Use taxonomy codes
You must include the taxonomy codes for both billing and rendering providers on all Texas Medicaid claims filed to Magellan, as of Sept. 1, 2022.*
Taxonomy codes are the administrative codes that identify the practitioner type and specialty for healthcare providers.
Make sure your claims get paid with these billing tips
Using these billing procedures can help ensure that Magellan can process your claims according to the Texas Medicaid guidelines. Review current clearinghouses or claims submission vendors to make sure they follow these procedures.
- If submitting paper professional claims, the billing taxonomy code should be in Box 33b preceded with qualifier ZZ and rendering taxonomy code should be in Box 24J with the qualifier ZZ in Box 24i.
- If submitting paper institutional claims, the billing taxonomy and attending taxonomy codes must be in Box 81a-81d with the appropriate qualifiers (B3 for billing and ZZ for attending).
- If submitting professional claims electronically, the billing taxonomy code should be in Loop 2000A (PRV*BI*PXC*282NR1301X~) and rendering taxonomy code should be in Loop 2310B (PRV*PE*PXC*1223G0001X~).
- If submitting institutional claims electronically, the billing taxonomy code should be in Loop 2000A (PRV*BI*PXC*282NR1301X~) and attending taxonomy code should be in Loop 2310A (PRV*AT*PXC*208D0000X~).
More information
Magellan notified you in June about this requirement that became effective Sept. 1, 2022. We posted the update about this change in Magellan’s Texas Medicaid provider handbook supplement.
To review the supplements for Magellan-managed Texas Medicaid plans, go to www.MagellanProvider.com/TXMedicaid.
Questions?
Contact us at CentralNetwork@MagellanHealth.com.
*The only exception is for Federally Qualified Health Clinic Services, which must include the taxonomy code for the billing provider only. All other providers must submit both the billing and rendering/attending provider taxonomy codes.