Claims Submission Requirements

Providers can submit claims either electronically or by mailing in a paper format. We strongly encourage you to use electronic transactions. Electronic transactions include:

• Claims submission
• Electronic funds transfer (EFT)
• Electronic remittance advice (ERA)
• Claim status and eligibility requests

Information required on paper claim forms is also required for electronic transactions.

Taxonomy codes

Our taxonomy code requirements can be found in the above claim form requirement documents.

Taxonomy codes are national specialty codes used by providers to indicate their specialty or provider type on a claim. When applying for a National Provider Identifier (NPI), you choose your provider taxonomy code(s). The Washington Publishing Company publishes the various provider specialty designations with their corresponding taxonomy codes.

Taxonomy codes indicated at the time of your NPI application are reflected on the confirmation notice document received from the National Plan and Provider Enumeration System (NPPES) along with the provider’s assigned NPI number. Current taxonomy code(s) registered with NPPES may be obtained on an inquiry basis by visiting the NPI Registry website.

View all the Health Care Provider Taxonomy Code sets.

Paper claim reminders

Paper claims are scanned and converted into electronic images once received. Please use the following guidelines to ensure your paper claims are successfully imaged:

• Do not use highlighters. The imaging equipment ‘blacks out’ highlighted information, making the information unreadable.
• Key or type all information. Handwriting and stamps are not always dark or legible enough to be captured by our imaging equipment. Note:  The Centers for Medicare & Medicaid Services (CMS) does not accept signature stamps.