Texas Medicaid

Medicaid Provider ID and NPI Crosswalk

Per HIPAA 5010 X12 standards, Medicaid is not allowed to receive a Medicaid provider ID on electronic claims, if the provider has an NPI.

Medicaid may tell you the wrong provider ID was sent on a claim, but this means their crosswalk did not match the correct provider ID.

The payer is using a table of information that tells them which provider ID to assign to the claim after it has been received.

This table or "crosswalk" of information normally includes:

- Provider NPI

- Provider Address

- Provider taxonomy code

Understanding Texas Medicaid Claims and TPI Assignment

When submitting claims to Texas Medicaid, it is important to note that the system does not directly accept TPIs (Texas Provider Identifiers) on the claims. Instead, Texas Medicaid applies a TPI to the claim after it has been received through an automated process known as a "crosswalk."

How the Crosswalk Process Works

The crosswalk process utilizes specific provider information to determine the appropriate TPI to apply to each claim. This information includes:

1. NPI (National Provider Identifier): The provider’s unique identification number. (Box 33 on the 837P form, Loop 2310B on the 837I form)
2. Billing Address: The address associated with the provider’s account. (Box 33 on the 837P form, Loop 2010AA on the 837I form)
3. Taxonomy Code: A code that specifies the provider’s specialty. (Box 33b on the 837P form, Loop 2000A on the 837I form)
4. Benefit Code (if applicable): This may be provided in box 11 of the claim form. (Box 11 on the 837P form, included in Loop 2300 on the 837I form)

Tips for Accurate Claims Submission

To ensure the correct TPI is applied, it is recommended to verify the following before submitting your claim:

1. Confirm Your Taxonomy Code:
   1. The taxonomy code used should match the provider’s registered specialty.
   2. This information is typically entered in box 33 of the claim form.
2. Double-Check Your Billing Address:
   1. Ensure the address on file matches the billing address submitted with the claim.

By adhering to these guidelines and ensuring all required fields are accurately completed, you can minimize processing delays and improve claim accuracy with Texas Medicaid.