Practice Support Update Blog

Taxonomy Enrollment Requirement Reminders for Claim Payment

Mar 16, 2022 9:30:00 AM / by Leslie D McDowell, DNP, ANP-BC, RN

Medicaid and prepaid health plans (PHPs) have identified a trend in claim denials related to taxonomy enrollment and credentialing. As a reminder, the taxonomy submitted on a claim for billing, rendering and attending providers must be a taxonomy for which the provider is enrolled with NC Medicaid. 


There are three levels of taxonomies: 

  1. Level 1 is the practitioner type (not used on claims), 
  2. Level 2 is Classification, and 
  3. Level 3 is the Area of Specialization. 

Providers enrolling with NC Medicaid select the appropriate taxonomy to the specificity desired for services rendered and must use that approved taxonomy on their claim. See the Provider Permission Matrix for taxonomies accepted for NC Medicaid. 

For example, if a provider is approved for Level 3 taxonomy 1041C0700X - Clinical, but uses the Level 2 taxonomy 104100000X – Social Worker on the claim, the claim will be denied. The provider must use the taxonomy approved on their NC Medicaid provider record. Review step by step illustrations from NCDHHS here


Tags: Medicaid Managed Care

  • There are no suggestions because the search field is empty.

Practice Support Services

Health care practices in North Carolina face many challenges. Our team of quality improvement coaches (QICs) have skills and expertise to support you in your transformation efforts.

To learn more about Practice Support Click Here

Apply for practice support services - fill out an application here

Subscribe to Blog Updates

Additional Resources:
Tip Sheets
Lib Guides
Interactive Resource Guides
Digital Library
New call-to-action
Join email list

Connect With Us:

Posts by Topic

See all

In Case You Missed It... Check Out These Recent Posts