The provider taxonomy code in most cases will not facilitate fraud
detection. Payers need to validate providers credentials at the point they
are enrolled. Internal payer systems, in many cases, already have the levels
of provider specialities comparable to provider taxonomy codes.  

-----Original Message-----
From: David Frenkel [mailto:gefeg@;att.net]
Sent: Tuesday, November 12, 2002 1:06 PM
To: WEDI SNIP Transactions Workgroup List
Subject: RE: Taxonomy Codes


Part of the use of NPI and taxonomy codes is to help track fraud.  A
good case in point are the surgeons in Redding, CA who are under
Medicare fraud investigation for doing unnecessary cardiac operations.
Not only have the procedures come into question but the surgeons were
not board certified to do these types of procedures.  There needs to be
a mechanism in place to easily audit for these types of abuses.

Regards,

David Frenkel
Business Development
GEFEG USA
Global Leader in Ecommerce Tools
www.gefeg.com
425-260-5030

-----Original Message-----
From: Jan Root [mailto:janroot@;uhin.com] 
Sent: Tuesday, November 12, 2002 8:35 AM
To: WEDI SNIP Transactions Workgroup List
Subject: Re: Taxonomy Codes

It's always possible that the NPI has been re-thought so that people
with multiple specialties (who have contracts where they get paid
different rates for those different specialties) would have more than
one NPI (one for each specialty under which they get paid a different
rate)...?  I guess we won't know until the final rule for the NPI is
published. That would be a significant change in it's initial inception.

Jan Root
UHIN Standards Manager

"Marshall E. Fryman" wrote:

> I was told by a Medicare rep that the Taxonomy Codes would be
discontinued
> with the implementation of NPI. I have no idea where she got that
> information, but she is a manager of the EDI department and it was at
an EDI
> seminar, so it may be accurate.
>
> Marshall
>
> > -----Original Message-----
> > From: Deanna Braun [mailto:Deanna.Braun@;sharp.com]
> > Sent: Monday, November 11, 2002 12:00 PM
> > To: WEDI SNIP Transactions Workgroup List
> > Subject: Taxonomy Codes
> >
> >
> > There has been alot of discussion regarding the Taxonomy Code and
> > electronic claims and referrals.
> >
> > Is the Taxonomy code just EDI-related, or will it also be
> > required on other formats (ie: HCFA 1500) and if so, where on the
form?
> >
> > Thanks.
> >
>
> ---
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