Specialists Incentive Program

HPSM offers an incentive program to contracted Medi-Cal, HealthWorx, Healthy Kids, CareAdvantage and Primary Care Providers that increases Medi-Cal allowable rates of 175% for certain Medi-Cal specialties. HPSM developed the program to improve access to specialty care, increase utilization and payment data, align reimbursement with market trends and respond to findings from the Provider Satisfaction Survey conducted last year.

The increase will apply to claims paid for dates of service from July 1, 2016 and ending June 30, 2020. Claims submitted without the appropriate taxonomy code and qualifier code (ZZ or PXC), will pay at the current rate (123% of allowable Medi-Cal). HPSM Claims Department will not accept claims resubmitted to include the taxonomy code.

What’s a Taxonomy Code?

Taxonomy codes are administrative codes set for identifying the provider type and area of specialization for health care providers. Each taxonomy code is a unique ten-character alphanumeric code that enables providers to identify their specialty at the claim level.

Taxonomy codes are used when applying for a National Patient Identifier (NPI) with the National Plan and Provider Enumeration System (NPPES).

Find Your Taxonomy Code

Claims Submission

The Specialists Incentive Program will require all selected specialists to include their taxonomy code on the claims form when submitting a paper CMS 1500 claims forms or electronic claims submission (837 files).

Paper Claims

Enter the taxonomy code in box 33b of the CMS1500 form.

SpecialistIncentiveCMS1500

Electronic Claims (837 file)

On the incoming electronic file (837), the segment is “PRV”, on different location/loop with different Code, For Billing / Submitting, loop 2000A, Code “BI” example: PRV*BI*PXC*207N00000X~

eHEALTHsuite

Currently, claims cannot be submitted with the taxonomy code via eHEALTHsuite.

For questions or information regarding the Specialty Incentive Program, please contact our Provider Services Department at 650-616-2106 or psinquiries@hpsm.org.