NUCC Provider Taxonomy - Health Level Seven International



NUCC Provider TaxonomyThe NUCC manages the content of the 1500 Health Claim Form. The code system of interest for C-CDA is actually the “Health Care Provider Taxonomy” from the NUCC – National Uniform Claim Committee. They have more than one “set of codes”: Condition codes, Provider Characteristics, and the Provider Taxonomy. Because of this the code system should not be simply called “NUCC” but instead called NUCC Provider Taxonomy.The “Condition Codes” are actually a subset of NUBC codes and so this is a value set using NUBS condition codes.“Provider Characteristics”: “This code list is for use with health care provider information for enrollment and credentialing transactions and their corresponding responses. It is intended to provide codified responses to questions presented to a health care provider applying to or registering with an entity and to report the outcome of such application or registration. It may also be used for responses to inquiries regarding provider participation or registration in a program or plan.” Therefore this is actually another NUCC code system.The Health Care Provider Taxonomy code set is an external, nonmedical data code set designed for use in an electronic environment, specifically within the?ASC X12N Health Care transactions. This includes the transactions mandated under HIPAA.The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. The Health Care Provider Taxonomy code set allows a single provider (individual, group, or institution) to identify their specialty category. Providers may have one or more than one value associated to them. When determining what value or values to associate with a provider, the user needs to review the requirements of the trading partner with which the value(s) are being used.The National Uniform Claim Committee (NUCC) is presently maintaining the code set. It is used in transactions specified in HIPAA and the National Provider Identifier (NPI) application for enumeration. Effective 2001, the NUCC took over the administration of the code set. Ongoing duties, including processing taxonomy code requests and maintenance of the code set, fall under the NUCC Code Subcommittee.Provider Taxonomy: The NUCC is managed by the AMA but the code system is freely available. The Chair of the committee is Nancy Spector (AMA Director, Coding and HIT Advocacy). Her number is 312-464-4586; email nancy.spector@ama-. She is willing to be the contact for the code system.Release site: is released January 1 and July 1 every year (twice a year.) CSV file format. This new version is identified using the published date may be used for content 3 months later – April 1 and Oct. 1. There is no notice system for updates, they just appear on the noted two dates. Modification and new codes are outlined on web pages, there is no update file. Latest release 7/1/2015. The CSV can be downloaded from the web site: Nancy has confirmed that AMA is willing to have the Provider Taxonomy be included in the UMLS. StructureThere are currently 838 codes with the structure noted in the table below. Review of the content indicates that the “Type” is a general grouper and apparently is not meant to be used without at least the “classification” characteristic also provided. In addition, when there are additional “Specialization” terms below a specific Classification, the code system provides a code for the “Classification” only. This means that while the “Type” string is to be included in the name and maybe useful for general grouping, “types” do not get their own codes and in fact function essentially as an attribute of the concept. As an attribute we can then potentially use them as search criteria when looking for specializations that occur in multiple codes.In C-CDA 2.0 specification (replicated in the 2.1 specification) the lack of a clear print name for the codes resulted in the specification using a made-up print name based on a pattern that used what appears to be an EN-dash with a space on either side. While this could work, when the NUCC committee was contacted about the proper description for the codes, they noted that the description must include type, classification, and specialization. They provided examples that indicate that the name is to be a concatenation of “;?“ between the Type and the Classification strings, and where necessary, a “,?“ between the Classification and Specialization strings. Codes are 10 digits and have no “logic.”Examples:CodeTypeClassificationSpecializationPrint name103TW0100XBehavioral Health & Social Service ProvidersPsychologistWomenBehavioral Health & Social Service Providers; Psychologist, Women104100000XBehavioral Health & Social Service ProvidersSocial WorkerBehavioral Health & Social Service Providers; Social Worker1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalBehavioral Health & Social Service Providers; Social Worker, Clinical1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolBehavioral Health & Social Service Providers; Social Worker, School106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistBehavioral Health & Social Service Providers; Marriage & Family Therapist111N00000XChiropractic ProvidersChiropractorChiropractic Providers; Chiropractor111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerChiropractic Providers; Chiropractor, Independent Medical Examiner111NI0900XChiropractic ProvidersChiropractorInternistChiropractic Providers; Chiropractor, Internist385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, ChildRespite Care Facility; Respite Care, Respite Care, Mental Illness, ChildThere is a place for a definition on each code but for many the definition is “to come…” There is also a note field that often has source information.The web site lists new codes and modifications on separate web pages. These seem to only discuss the current release. It is unclear if code meaning permanence is maintained in the modification process.OIDsThe code system is registered at HL7 with the name “Health Care Provider Taxonomy,” short name “providertaxonomy”, and OID 2.16.840.1.113883.6.101. This OID is used in all the MU-related specifications but the name seems to be somewhat variable. We should use the official name I’ve noted here. The value set that references this seems to have the entire code system included and is named “Healthcare Provider Taxonomy (HIPAA)” with OID 2.16.840.1.114222.4.11.1066.The American Medical Association (AMA) on behalf of the National Uniform Claim Code Committee (NUCC) grants you and your organization (you) a non-exclusive, royalty-free, non-transferable permission to use and distribute the Health Care Provider Taxonomy Code Set (Provider Taxonomy) that includes the AMA's copyright notice and is posted on and to incorporate and distribute the Provider Taxonomy in your products in the United States (Products) subject to the following agreements:In consideration of this permission, you will not change the Provider Taxonomy (except for format and stylistic changes necessary to incorporate the Provider Taxonomy in the Products) or create derivative works of the Provider Taxonomy;You acknowledge the AMA holds copyright in the Provider Taxonomy on behalf of the NUCC and you will include all notices, disclaimers and attribution statements as included in the Provider Taxonomy on any copy of the Provider Taxonomy;You may not use the name of the AMA, the NUCC, or any of the NUCC members in the promotion of your Products other than to state that the Products include the Provider Taxonomy without any statement or implication of endorsement of your Products;You acknowledge that the Provider Taxonomy is provided "AS IS" without warranty of any kind;You agree that the neither the AMA, the NUCC, nor any of the NUCC members shall be responsible for any consequences, including liability or damage attributable to or related to any use, non-use, or interpretation of information contained or not contained in the Provider Taxonomy;You acknowledge that the Provider Taxonomy is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which were developed exclusively at private expense by the NUCC and the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.You shall only license the Provider Taxonomy in your Products to third parties consistent with the terms of this Permission;Any use not authorized is not permitted and the AMA may terminate this permission if you violate its terms; and9 This permission shall be governed by Illinois law without regard to choice of law principles and shall remain in effect for three years from your date of acceptance.License infoNote that vendors must request a license to include this in a product: “Vendors interested in incorporating the Health Care Provider Taxonomy code set into their commercial products must complete the license request form found on the CSV page.” Using this form: that just notes the license info below and asks for contact information.Nancy has confirmed that for notice of licensure all that would be needed is the following sentence:For information on the Health Care Provider Taxonomy code set licensing requirements, please see .AMA licensing contact number: 312-464-5022 (AMA IP services) ................
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