Provider Type and Provider Specialty - University of Iowa ...

[Pages:8]Master Appendix

Provider Type and Provider Specialty

Provider Types and Provider Specialties

The provider type indicates what "kind" of provider is doing the billing. Provider types include individuals, facilities, and vendors. The provider's specialty is a value indicating what field of medicine a provider has additional education in to make him/her a specialist in a certain field.

NOTE: Provider type codes may not be unique to one provider type. A good example is provider type 20 says MD/DO but it is used on PHD, old social workers records and CRNA's and SD providers due to pricing issues. Be sure to look at the type in conjunction with the specialty.

Specialty Code 00 00 00 01

02

03

04

05

06

07

Type Code

90 98 99 20/22

20/22

20/22

20/22

20/22

20/22

20/22

Description

Specialty

Type

Any specialty

Miscellaneous

Any Specialty

Out of country

Any Specialty

Out of area

General Practice (MD/DO Occupational Medicine)

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

General Surgery

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Allergy

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Otology, Laryngology, Rhinology (Otolaryngology)

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Anesthesiology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Cardiovascular

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Dermatology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Provider Type and Provider Specialty Wellmark BCBS

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Master Appendix

Provider Type and Provider Specialty

Specialty Code 08 09 10 11 13 14 15 16 17 18 20 21 22

Type Code 20/22 20/22 20/22 20/22 20/22 20/22

17 20/22

17 20/22 20/22

21 20/22

Description

Specialty Family Practice

Type

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Pain Management (effective Physician (M.D. or

01/06/05)

D.O.)/Group Physician

(Multiple Physician Practice)

Gastroenterology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Internal Medicine

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Neurology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Neurological Surgery

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Pastoral Counselor (SD FEP Counselor only)

Obstetrics-Gynecology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Licensed Counselor (SD FEP only)

Counselor

Opthalmology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Orthopedic Surgery

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Community Mental Health Center

Community Mental Health Center

Pathology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Provider Type and Provider Specialty Wellmark BCBS

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Master Appendix

Provider Type and Provider Specialty

Specialty Code 23 24 25 26 27 28 29 30 31 32 33 34 35

Type Code 20/22 20/22 20/22 20/22 20/22 20/22 20/22 20/22

19 20/22 20/22 20/22

30

Description

Specialty Sleep Medicine

Type

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Plastic Surgery (Reconstructive Surgery)

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Physical Medicine and Rehabilitation (Physiatrist)

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Psychiatry

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Radiation Oncology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Colorectal Surgery (Proctology)

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Pulmonary Diseases

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Radiology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

MRI (Magnetic Resonance X-Ray Type Supplier Imaging)

Perinatology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Thoracic Surgery

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Urology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Chiropractic

Chiropractor

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Master Appendix

Provider Type and Provider Specialty

Specialty Code 36

37

38

39

40

41

42 42 43

44

45 46

47 48 49 50

Type Code 20/22

20/22

20/22

20/22

20/22

20/22

20/22 33

20/22

20/22

45 20/22

19 32 70 20/22

Description

Specialty Nuclear Medicine

Type

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Pediatrics (Neonatology)

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Geriatrics

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Nephrology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Hand Surgery

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Emergency Medicine (ER)

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Nurse Midwife (South Dakota Only)

Nurse Midwife

Nurse (ARNP)

Certified Registered Nurse Anesthetist (CRNA)

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Infectious Diseases

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Speech Therapy (used for FEP)

Endocrinology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Freestanding Mammography X-Ray Type Supplier Center

Podiatry

Podiatrist

Surgery Center

Nurse Practitioner (South Dakota only)

Provider Type and Provider Specialty Wellmark BCBS

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Master Appendix

Provider Type and Provider Specialty

Specialty Type Code Code Specialty

Description Type

50

33 Nurse Practitioner

Nurse (ARNP)

51

19 PET Scan

X-Ray Type Supplier

52

52 Orthotics and Prosthetics

53

53 Freestanding Sleep Centers

54

17 Licensed Marriage Family Therapist (LMFT)

55

17 Licensed Mental Health Counselor (LMHC)

57

57 Federally Qualified Health Centers (FQHC)

59

59 Ambulance

60

44 Home Health Agency (prov. # begins with 67_ _ _)

60

60 Public Health, Welfare or Rural Health

60

72 Hospice

61

61 Public Health, Voluntary Health or Charitable Agencies

62

20 Psychologist (Billing

Independent)

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

63

19 Portable X-ray Supplier

X-Ray Type Supplier

(billing independently)

63

24 Independent Physiological Lab

64

40 Audiologist

65

34 Independent LPT (Licensed Physical Therapist)

65

34 Allied Health Clinics (for special processing as professional

provider)

66

20/22 Rheumatology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

67

58 Occupational Therapist

69

23 Independent Laboratory (Billing Independently)

70

22 Multi Specialty Clinic

Group Physician (Multiple Physician Practice)

71

19 Freestanding Radiology

X-Ray Type Supplier

Center

72

19 Freestanding Radiation

X-Ray Type Supplier

Oncology Center

Provider Type and Provider Specialty Wellmark BCBS

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Master Appendix

Provider Type and Provider Specialty

Specialty Code 73 74

75 75 76

77

78

79

80

80 81

82

86

Type Code

34 20/22

28 29 20/22

20/22

20/22

20/22

20/22

38 20/22

20/22

25

Description

Specialty Physiotherapy

Type

Qualified Mental Health

Physician (M.D. or

Professional (QMHP) (South D.O.)/Group Physician

Dakota only)

(Multiple Physician Practice)

Optometrist

Dispensing Optician

Peripheral Vascular Disease Physician (M.D. or

(effective 01/06/05)

D.O.)/Group Physician

(Multiple Physician Practice)

Vascular Surgery (effective 01/06/05)

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Cardiac Surgery (effective 01/06/05)

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Cardiac Electrophysiology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Licensed Clinical Social Worker (should not be using this--use 80/38 when WHPI) (only LSW under CMHC)

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Licensed Clinical Social Worker (All LISW)

Critical Care (Intensivist) (effective 01/06/05)

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Hematology

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

Intermediate Care Facility Government Hospital

Provider Type and Provider Specialty Wellmark BCBS

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Master Appendix

Provider Type and Provider Specialty

Specialty Code 86

86 86 86

Type Code

63

63 64 65

Description

Specialty

Type

Acute Care (60_ _ _ ),

Hospital

Swing Bed (6U_ _ _),

Rehab Center (6T_ _ _), Psychiatric (6S_ _ ),

Alcohol/Drug (6V_ _ _),

Mental Health (64_ _ _),

Renal (ESRD)

Community Mental Health Center (starts with `646'), or Mental Health Facility (starts with `640')

Psychiatric Mental Institute for Children (PMIC)

Hospital

Government VA Hospital

86

68 Substance Abuse and Alcohol Abuse (68_ _ _)

86

71 Birthing Center

86

80 Skilled Nursing Facility (65_ _ _)

Swing Bed or Rehab (66_ _ _)

86

81 Home Infusion Therapy

87

26 Pharmacy (IPSC/Blue Rx/CMM)

87

69 Home Medical Equipment

88

ANY Dummy specialty used on dummy provider numbers

89

20 Clinical Nurse Specialist (South Dakota only)

89

33 Clinical Nurse Specialist

90

20/22 Medical Oncology

91

27 General Dentist

Physician (M.D. or D.O.)/Group Physician (Multiple Physician Practice)

92

27 Oral Surgeon

93

27 Orthodontist

94

27 Pedodontist

95

27 Periodontist

96

27 Endodontist

Provider Type and Provider Specialty Wellmark BCBS

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Master Appendix

Provider Type and Provider Specialty

Specialty Code

97 97 98

Type Code

20 40 27

Description

Specialty

Type

Physician Assistant (South Dakota only)

Physician Assistant

Prosthodontist

Provider Type and Provider Specialty Wellmark BCBS

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