fsgl wrote on Saturday, October 03, 2015:
Since our local Blue Shield required a taxonomy code on all claims last June, the solution in the previous thread has worked well for e-claims. Occasionally a paper claim is necessary. The Transaction Set Trailer tallies the segments for each claim rather than all the segments in one batch. As a result our local Blue Shield rejects corrected claims as being duplicates. We have no choice but to submit paper claims when this happens.
Adding the taxonomy code to Box 33b is straightforward. See attachment 1. The entry in magenta would be the code for the specialty.
It was a bit more complex to add the ID Qualifier (in green) to Box 24i & the code to Box 24j, shaded sections; because it was not obvious which row was the correct one to address. Additionally both had to appear for each charge; therefore if there were 5 charges in Box 24, the 5 corresponding shaded boxes needed insertion. Fortunately the $lino function came to the rescue. See attachment 2c.
If the ID Qualifier was also necessary in Box 33b, it would be inserted as a prefix to the taxonomy code.
Our local Medicare carrier never permitted insurer name & address to appear in the upper right hand corner of the CMS 1500 form. A workaround is to add 2 forward slashes to Lines 91, 92, 93, 96 & 97 thus uncommenting them. Uncommenting Lines 514, 515 & 689 would work for non-Blue Shield claims.
It would be more elegant to write conditionals to remove name/address for Medicare & insert the qualifier/taxonomy code for Blue Shield, but commenting/uncommenting is less labor-intensive than our other workaround of creating a carrier for Medicare paper claims without the offending information or using the typewriter to insert the taxonomy code for Blue Shield claims.
Office Ally has informed us that it is not necessary to remove the taxonomy code for insurers which don’t require it. It is a prerequisite for a number of Blue’s & Medicare institutional claims; therefore it’s probably safe to have the taxonomy code on all claims. Doing so avoids the confusion of missing data for insurers who demand the information, thus forestalls rejection from those carriers.