Claim edit: Taxonomy code not in the NUCC code set

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include a provider taxonomy code that isn't in the NUCC Health Care Provider Taxonomy code set.

How the edit works

A taxonomy code identifies a provider's classification and specialization, such as cardiology or orthodontics.

The National Uniform Claim Committee (NUCC) maintains and publishes valid taxonomy codes in the Health Care Provider Taxonomy code set. Stedi checks the taxonomy code for every provider on the claim, including billing, rendering, attending, referring, and assistant surgeon providers, at both the claim and line level.

If a claim includes a taxonomy code that isn't in the NUCC code set, the payer may reject the claim. This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which take longer to resolve and delay payment for the provider.

Rejection errors

If you submit a claim using Stedi's Claim Submission API endpoints and the claim fails the edit, you'll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Taxonomy Code. The submitted taxonomy code, ABC123456X, for Billing Provider is not valid per NUCC. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim using SFTP and the claim fails the edit, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, entity identifier code, and error message:

STC*A7>145>85*[DATE]*U*[AMOUNT]********Invalid Taxonomy Code. The submitted taxonomy code, ABC123456X, for Billing Provider is not valid per NUCC. Correct and resubmit.~

Related claim edits

Stedi has another edit that checks the taxonomy code format. See Invalid taxonomy code.