We are seeing increased scrutiny among the various provider credentialing and certification entities in the past year. These entities are cross-referencing provider data with other sources to ensure consistency / accuracy. Specific examples include: IL Medicaid (IMPACT) requiring that Taxonomy (specialty) codes used in their credentialing process match the provider’s NPPES NPI Registry; and, Taxonomy codes used in Medicare PECOS credentialing must match what was used in the provider’s CLIA enrollment. Mismatched information will result in claim denials and the specific claim adjustment reason / remark codes to watch for include B7-“provider was not certified / eligible to be paid for this service” and, N95-“provider type/provider specialty may not bill this service”. We encourage all providers to review their credentialing information within CAQH, PECOS, NPPES NPI Registry, any state-specific Medicaid programs and certifications to ensure all reflect the same Taxonomy code(s).
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