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REF. Taxonomy codes should be submitted on claim forms as follows: ADA 2019 claim form Box 56a should contain the taxonomy code CMS-1500 claim form Rendering Provider Box 24i should contain the qualifier ZZ Box 24j should contain the taxonomy code Billing Provider Box 33b should contain the qualifier along with the taxonomy code Taxonomy code is constructed of 10 digits- numeric and alpha: (see example 1) Placement of Taxonomy and Qualifier Tips: Qualifiers are to be included on both paper and electronic claims for proper submission of claims Provider should be billing with the taxonomy that is filled with DCH Get Medicare billing update instantly Display the NPI# according to the rules below. 207W00000X (Ophthalmology) endobj
This code list is a National Uniform Claim Committee (NUCC) property. identification and/or taxonomy numbers are either missing or do not match the records on file. %
Each taxonomy code is a unique ten character alphanumeric code that enables providers to identify their specialty at the claim level. 3) If Separate Account in LE is NO, it will show the value from Primary Legal Entity. Each year the Centers for Medicare and Medicaid Services (CMS) rolls out the proverbial carpet and ushers in new rules on regulatory compliance, coding and reimbursement. POS selected in the Charge Entry/Charge Master screen. The billing provider taxonomy code that is submitted on the claim needs to be a taxonomy code that DMAS expects to receive based on how the provider is enrolled Mass immunizers may use a roster bill or submit a traditional claim form, such as a CMS-1500 form (PDF) or the 837P electronic format. Displays the NPI# of the selected Service Location in the claim. 24.e. . 9. @i;pU- }@pHK00Ui00zMb0 ] 3
This page is for people who would like to get information about 101Y00000X Taxonomy code. Name of OTHER PAYER. An official website of the United States government. Insured person DOB and SEX of destination payer. CMS SPECIALTY CODES/HEALTHCARE PROVIDER TAXONOMY CROSSWALK . And to get an NPI, your application will need to include the taxonomy code that reflects your classification and specialization. You can apply for an NPI at: www.cms.hhs.gov . Taxonomy does not exist for Billing Provider. 6. JavaScript is disabled. State Government websites value user privacy. This notification is an update to a previous communication regarding taxonomy code requirements for the CMS-1500 form and UB04. Both the billing provider and the attending/rendering provider should include their own taxonomy codes on the claim. Waiver providers billing atypical services with their NPI must use the taxonomy code 174400000X to identify it as a waiver service. Enter your NPI Number into the field, and then click Search. A Type 2 NPI is an entity/organization NPI. Insured person DOB and SEX of other payer in Insurance Information screen under Patient Master. Peach State Health Plan will reject the claim if the taxonomy codeis incorrect or omitted from the claim. July 1, 2022. . Name of the INSURED PERSON of the destination payer in Insurance Information screen under Patient Master. Please reach out and we would do the investigation and remove the article. Taxonomy Code(s) Billing Loop (2000A), PRV segments - PRV02 = PXC PRV03 = taxonomy code. CODE field under Encounter tab within Charge Master. Usage: This code requires use of an Entity Code. When applicable, a rendering/attending taxonomy code should also be submitted and should be valid, based on the service rendered and the rendering/attending provider location. Click the Referring Dr. tab. NOT REQUIRED . number or CPT codes will delay payment or may result in rejection of the claim because of incomplete information. Enter the patient's Medicaid identification number 2 . The following PHP denial/rejection codes may indicate claims have missing/invalid taxonomy codes: Attending not enrolled in Medicaid Program*, Billing Prov not enrolled in Medicaid Program*, Rendering Prov not enrolled in Medicaid Program*, ACK/REJECT INVAL INFO Payer Assigned Claim Control Number INVALID PAYER CLAIM CONTROL NUMBER SUBMITTED BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED ACK/REJECT MISS INFO Entitys specialty/taxonomy code. Please contact the Provider Relations department at x-xxx-xxx-xxxx to resolve this issue. All the articles are getting from various resources. 9.d. Per the California Official Medical Fee Schedule (OMFS) the reimbursement amounts for treatment can differ based on the providers Taxonomy Codes. 4 0 obj
The code set is published and released twice a year, in January and July. To avoid any claims processing errors, providers should complete their claims with the same information that was included on the prior authorization request. 8. endobj
Display value in RESERVED FOR LOCAL USE. Enter the clinician's NPI in the NPPES NPI Registry. January 2023 Taxonomy Code Set Updates Released. 261QC0050X Critical Access Hospital. View the entire data set at data.cms.gov, where you can choose from a variety of download formats to see the entire list. You won't have enough room to enter the full code if you CMS has developed a taxonomy code crosswalk that connects the types of providers and suppliers who are eligible to apply for Medicare enrollment with the appropriate Healthcare Provider Taxonomy Codes. "=f IF:[.`W_"vy.Ml~XL*Mc` ?
Rendering Provider Taxonomy Code is missing. Finding Medicare fee schedule HOw to Guide, Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee, LCD and procedure to diagnosis lookup How to Guide, Medicare claim address, phone numbers, payor id revised list, Medicare Fee for Office Visit CPT Codes CPT Code 99213, 99214, 99203. (CMS) MLN Matters SE20011 provides more information on the use of Condition Code DR and Modifier CR for COVID-19 related Medicare claims. %%EOF
A taxonomy code is a ten-character alphanumeric code that allows you to identify your specialty to an insurance payer (e.g., Speech-Language Pathologist or Physical Therapist). As a provider, do I need to know my taxonomy code? To enroll, you must have an NPI. the CMS-1500 (08/05) or in the Rendering Provider ID field on the 837P electronic claim submission. <>
17.b. EMPLOYER name of the other payer insured person in Insurance Information screen under Patient Master. A providers taxonomy code can easily be found on the National Plan & Provider Enumeration System (NPPES) website. The code set is updated twice a year, with the updates being effective April 1 and October 1 of each year. BCBS prefix Why its important to read correctly. 17 Name of REFERRING PROVIDER from Charge Entry/Charge Master. DMAS does not provide CMS-1500 and CMS-1450 (UB-04) forms. DOS FROM & TO entered in Charge Entry/Charge Master screen. The taxonomy code is 1041C0700X. Field 24I (ID Qualifier): Enter ZZ. For a better experience, please enable JavaScript in your browser before proceeding. If this is your first visit, be sure to check out the. Patient DOB and SEX from Patient Master. Medicare COB : 003 Optical Services . [On the Top Colored area] NPI# or the rendering provider from Provider Master. When billing with a Type 2 NPI the entity's billing taxonomy code is required. billed on CMS 1500. 2310A PRV01, 02, 03. Required when applicable and for any waiver-related services. Below are the procedure code modifiers that must be billed as the primary modifier by the facility/provider that performed the service, if You must also check to the indicated below: * This requirement is normally payer specific and you should verify with individual payers as to the exact requirements prior to customizing these settings. When submitting claims to PHPs, please continue to submit the appropriate billing provider taxonomy which is expected to be consistent with the taxonomy on your NCTracks provider record and valid for the service rendered. This will be YES if there is multiple payers for the patient in the Patient Master, and NO if there are no other payers for the patient. administrative code set (CMS 1500 ) - required codes for various data elements. Submission of claims with missing or incorrect taxonomy codes will cause the claims to deny and delay provider payments. 24.d. endobj
Type the taxonomy code in the Facility ID (32b) text box. This list incorporated all types of providers associated with health care in various ways, e.g. 10.d. 10d field under Others tab in Charge Entry/Charge Master screen. 4. You are using an out of date browser. endstream
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For more information on filing compliant CMS-1500 Forms, please review DaisyBills California Billing Guide. Refer to the July 9, 2021, Common Billing Error: Taxonomy Codes Missing, Incorrect or Inactive bulletin for additional guidance on submitting valid taxonomy codes. It is not intended to allow the billing of 12 lines of . . Forums Medical Coding Billing/Reimbursement ZZ and PXC are the qualifiers that apply to the provider taxonomy code. Scenario One: Rendering NPI is different than the Billing NPI CMS 1500 Form Required Data . :[p0k,vbE1s"E/jvI,81x7~'qe,IA7A{`8&
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Taxonomy codes must be included when submitting claims to prepaid health plans This is a reminder to providers that taxonomy codes must be included when submitting claims to prepaid health plans (PHPs), whether the claim comes from the individual provider or through a clearinghouse. Claims Denied - Taxonomy Codes Missing, Incorrect, Or Inactive. Provider Taxonomy (The qualifier in the 5010A1 for Provider Taxonomy is PXC, but ZZ will remain the qualifier for the 1500 Claim Form.) 682. a) If Primary LE organization type is SOLO, it will show the NPI# of Rendering Provider. Providers may submit multiple rendering provider NPI and taxonomy at the line level on the CMS 1500 form, but rendering provider NPI and taxonomy can only be submitted at the claim level on the 837. PR0029 V1.5 01/24/2018 . INVALID PAYER CLAIM CONTROL NUMBER SUBMITTED ACK/REJECT INVAL INFO Payer Assigned Claim Control Number ACK/REJECT MISS INFO Entitys specialty/taxonomy code. 28 . Usage: This code requires use of an Entity Code. Study with Quizlet and memorize flashcards containing terms like A HIPAA mandated electronic transaction for claims may also be called, What organization determines the content of both HIPAA 837 and CMS 1500 claims?, You need to send a claim to a payer who does not accept electronic claims.Identify the claim form you would use to send a paper claim. CMS-1500 Claim Form UB-04 Form Locator; Billing Provider Taxonomy Code - required on all claims: 2000A, PRV03: Box 33b w/ ZZ qualifier preceding the taxonomy code: Box 81cc A w/ B3 qualifier: Rendering Provider Taxonomy Code - required on Professional claims when Rendering Provider information is submitted at the claim and/or service line . For a specific payer, please see: Box 33: Insurance Specific Billing Provider. . Note: You may select more than one code or code description when applying for an NPI, but you must indicate one of them as the primary code. ?]wo~?/93~x@s?J GW/-o}K3.TlAzu/^:}WW7_c`>Aq?>?=7.O{j-9=iWW/ern7/^wnvm)xssq)5 WebThe following are the most common reasons HCFA/CMS-1500 and UB/CMS-1450 paper claims for Veteran care are rejected: Requires the 17 alpha-numeric internal control number (ICN) [format: 10 digits + "V" + 6 digits] or 9-digit social security number (SSN) with no special . This may not necessarily be the supervising provider. As such, all providers with NPIs will have self-identified with at least one provider taxonomy code. The taxonomy code is designated by the provider in order to identify his or her provider type, classification and/or area of specialization. This should be the NPI of the health department's nurse practioner or supervising . NOTE: DO NOT use commas, periods, space, hyphens or other punctuations between the qualifier and the number. . You must log in or register to reply here. How to TRANSITIONING/TRANSFERRING OF ENROLLEES to MCO, What is Patient driven Grouping model how its working, Workers Compensation Medicare Set-Aside Arrangement (WCMSA) Full coverage, Understanding Medicare cost Reports and usage. If all the 3 are entered it will take ONSET OF CURRENT ILLNESS. The code-code field of the UB04 can be used to communicate the The Healthcare Provider Taxonomy Code Set is available from the Washington Publishing Company (www.wpc-edi.com) and is maintained by the National Uniform Claim Committee (www.nucc.org). The code set is divided into three distinct Levels, which include Provider Grouping, Classification, and Area of Specialization. %%EOF
14 Display the ONSET DATE OF CURRENT ILLNESS or ACCIDENT DATE or DATE OF PREGNANCY from the Others tab in Charge Entry/Charge Master. 5. <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 12 0 R 20 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
This is a reminder to providers that taxonomy codes must be included when submitting claims to prepaid health plans (PHPs), whether the claim comes from the individual provider or through a clearinghouse. Professional claims. BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED ACK/REJECT MISS INFOR Entitys specialty/taxonomy code. You will use this code when applying for a National Provider Identifier, commonly referred to as an NPI. You can decide how often to receive updates. Your NPI number should only be used in box 33a and 24j. For billing purposes, the taxonomy code is entered into Field 24J Grey on the CMS-1500 form. (Required if applicable.) I have questions because Medicaid helpdesk is giving me conflicting answers. Hands down the best way to quickly determine up-to-date reimbursements and past dates of service. 81a with B3 qualifier. Specialist. Online Provider Taxonomy code lookup. Patient GROUP # of the other payer in Insurance Information screen under Patient Master. CMS systems will accept roster bills for 1 or more patients that get the same type of shot on the same date of service. Box 17a, 19, 24i, 32b, 33b - Identifier Qualifiers. the NPI and taxonomy code in 24J. Providers must enter this taxonomy code in both the billing and the servicing taxonomy fields on the CMS-1500 (HCFA) claim form. 9.a. If you are a health, Read More How do I add a taxonomy code to my NPI?Continue, What is Taxonomy? Shows the UNITS against each CPT entered in Charge Entry/Charge Master. hb``d``c ,l@qm{$9'' O=ME#+:::@ i VT03- `t0e
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For the CMS-1500 version 02/12, the Taxonomy code associated to the Rendering Provider billed in Box 31 is placed within Box 24J (shaded) for each line billed on the claim. Below are three scenarios with Billing Requirements for each scenario. The Healthcare Provider Taxonomy code set is an external, nonmedical data code set designed for use in an electronic environment, specifically within the ASC X12N Healthcare transactions. 10-digit NPI number of the individual . View the complete data set on data.cms.gov, where you can select various download formats to view the entire list. CMS Forms; Home; Healthcare Lookup Services; Taxonomy Codes Lookup; 367500000X; 367500000X Taxonomy Code Nurse Anesthetist, Certified Registered . .gov A taxonomy code describes the Provider or Organizations type, classification, and area of specialization. I need to change the number or simply enter it into the software system. On electronic claim submissions using the ASC X12N 837P and 837I format, taxonomy codes are placed in segment PRV03 and loop 2000A for the billing stage, and segment PRV03 and loop 2420A for the rendering level. Display Y if FAMILY PLAN check box is selected under Others tab in Charge Entry. 363A00000X. The California Billing and Payment Guide issued by the Division of Workers Comp (DWC) requires providers to complete the CMS-1500 Form with the taxonomy code of the rendering provider when the rendering provider is a health care provider. Yes, if you want to become a Medicare provider. Display the NDC code Details for J codes on the top colored area above the CPT code. If you need help identifying your taxonomy code, or have other questions about the enrollment process, please contact us. 33 Display the details according to the rules below. The information may also be given to other providers of services, carriers, intermediaries, medical review boards, health plans, and other . How to Setup Taxonomy Codes in Medisoft for Paper CMS-1500 Form - YouTube Gavin demonstrates how to setup the taxonomy code so it will print on a CMS-1500 claim form. 3. means youve safely connected to the .gov website. 3) If Separate Account in LE is NO, it will show the Primary Legal Entity Name & Address. 24j. For example, a chiropractor (111N00000X - CHIROPRACTOR) receives greater reimbursement than a physician assistant (363A00000X - PHYSICIAN ASSISTANT). ( Taxonomy may be needed to establish a one-to-one NPI/LPI match if the provider has multiple locations. 010 Physicians : 837P . There are two ways to submit claims to the Montana Healthcare Programs: Electronic and paper. If you find anything not as per policy. 19 Display value in RESERVED FOR LOVAL USE. To validate your taxonomy code, please use the NCTracks How to view and update Taxonomy on the Provider Profile in NCTracks User Guide. Primary care (pcp) 363AM0700X. 2418 0 obj
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2. For billing purposes, the taxonomy code is entered into Field 24J Grey on the CMS-1500 form. Some payers require the provider's taxonomy code be listed in Box 33b. Who Needs Taxonomy Code? Insured person information like ADDRESS, CITY, STATE, ZIP CODE & PHONE of destination payer in Insurance Information screen under Patient Master. taxonomy code if the NPI is entered in locator 33a open line. It is a one-of-a-kind 10-character code that denotes your classification and specialization. 261QC1800X Corporate Health. hb```b``fe`a``cg@ ~r``xJwEC0H >(f`gcieMmu Attending Provider Taxonomy Code. 33.b. Usage: This code requires use of an Entity Code. "ZZ" for a paper CMS-1500 form in block 33b "PXC" for 5010A1 electronic submissions in loops 2000A, segment PRV03 Do not include spaces or hyphens in your taxonomy codes. Taxonomy codes are administrative codes set for identifying the provider type and area of specialization for health care providers. It complies with the National Standardized Billing Standards and is required for the accurate and timely claim processing. 0
The Health Care Provider Taxonomy code is a ten-character alphanumeric code that is unique. You will use this code when applying for a National Provider Identifier, commonly referred to as an NPI. b) If Primary LE organization type is NOT SOLO and, 1) If Separate Account in LE is YES and organization type is NOT SOLO, it will show the NPI# of Legal Entity. Official websites use .govA [if claim is for primary insurance other payer is secondary insurance, similarly if claim is for secondary insurance other payer is primary insurance and if claim is for tertiary insurance the other payer is secondary insurance] 20 YES if OUTSIDE LAB option is selected and NO if not, also display the LAB CHARGES value from Lab tab in Charge Entry/Charge Master. Patient DOB and SEX from Patient Master. 2022 Annual 1500 Instruction Manual Release. PATIENT NAME from Patient Master. You must log in or register to reply here. To do this: 3. I have Medicaid denials due to the taxonomy code being improper/missing from the CMS1500 electronic form. Each taxonomy code is a unique ten . Patient MARITAL STATUS, EMPLOYMENT STATUS & STUDENT STATUS from Patient Master. To give you a much clearer idea, let us first talk about the general structure that all the Taxonomy codes follow. 24.j. and more. 30 Displays TOTAL BALANCE AMOUNT for this claim, 31 Displays RENDERING PROVIDER NAME, SIGNATURE ON FILE & CLAIM DATE. The lower portion of the CMS 1500 claim form ( item numbers 14-33 ) : A providers taxonomy code can easily be found on the. &
||AO=G]?Q t3/w 4pFsZN.m1F]jh;x6>nsI*nPhu;uL[JiukXw*vEs\)RVAJR(A\GclcX.prJV|PN6Z|rS']6f&h[a6sv},Y2VE{osDi 7;G~>btU:Gtivik-'&iAk/h"3Z This table reflects Medicare Specialty Codes as of April 1, 2003. Taxonomy code is constructed of 10 digits- numeric and alpha: (see example 1), Tips: %PDF-1.6
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This setting can be managed in your global insurance company settings > HCFA 1500 tab. Select Provider Taxonomy from the Qualifier (17a) drop-down menu. 21 Display first 4 DIAGNOSIS from the Charge Entry/Charge Master screen. How Do I Add A Taxonomy Code To My Claim Form? a) If Primary LE organization type is SOLO, it will show the value from Rendering Provider. Clearinghouses may be updating taxonomy information submitted by providers, so it is important that providers work with their clearinghouse to ensure valid taxonomy data is submitted to the PHPs on their claims. You can find a full list of taxonomy codes on the Washington Publishing Company (WPC) website in the Health Insurance Portability and Accountability Act (HIPAA) related code list section, at http://www.wpc-edi.com/products/codelists/alertservice. If you are a behavioral health facility that bills Anthem at the organizational level on the CMS 1500, report the following taxonomy codes in the Billing Taxonomy field on the CMS-1500 (paper - field 33b, electronic - Loop 2000A/Segment PRV - field . 33.a. A taxonomy code is a one-of-a-kind 10-character code that denotes your classification and specialization. Box 24G requires a unit of at least "1." Key fields for proper paper claims submission The following key fields must be entered correctly on the CMS-1500 (02/12) claim form to ensure timely and accurate To find the taxonomy code that most closely describes your provider type, classification, or specialization, use the National Uniform Claim Committee (NUCC) code set list. INSTRUCTIONS FOR USE OF THE CMS-1500 (02-12), BILLING FORM . *PHP may be updating their denial/rejection code description. The anesthesiology codes cannot be used to derive COS 030. 337 0 obj
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. If you have a Payer requirement to display a Taxonomy code on your HCFA claims form, this will normally display in either HCFA Box 24j or Box 33b. 1.a. Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, Medicare revalidation process how often provide need to do FAQ, Step by step Guide Medicare participation program. 12 & 13 are on file and enter the SIGNATURE DATE under Authorization Information section in Other Attributes page in Patient Master. The NUCC provider taxonomy codes can be very detailed and will provide enough granularity for most research purposes. Location Number (This qualifier is used for Supervising Provider only.) The page numbers in parentheses correspond to the taxonomy publication, version 4.1, dated July 2004. A taxonomy code describes the Provider or Organization's type, classification, and area of specialization. CMS-1500 Form Requirements Item Number 19 Instructions Do not enter a space, hyphen or other separator between the qualifier code and the number. The revenue codes and UB-04 codes are the IP of the American Hospital Association. 1240-0044 Expires: 06/30/2024.
PLEASE NOTE: A system enhancement was configured on December 12, 2014 to allow claims to process accordingly for any that may have rejected when billed with the following requirements. endstream
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Please compare the information submitted to the information registered with the state of North Carolina. . TAXONOMY PLACEMENT ON A CLAIM CMS 1500 PAPER SUBMISSION: Rendering - Box 24i should contain the qualifier "ZZ." Box 24j (shaded area) should contain the taxonomy code. Displays 2 character SECONDARY ID TYPE Qualifier & SECONDARY ID for the rendering provider against the billed insurance entered in Setup Insurance page under Provider Master. If a clearinghouse does not submit a taxonomy or if the taxonomy is incorrect, these errors may increase the providers claim denials with the PHPs they submit claims to. ) A Type 1 NPI is an NPI for a person. Taxonomy Code Requirement effective March 1, 2017 Updated February 9, 2017 . CMS 1500 (02/12) CLAIM FORM INSTRUCTIONS . Taxonomy codes are assigned to both individual and organizational providers. Please compare the information submitted to the information registered with, Common Billing Error: Taxonomy Codes Missing, Incorrect or Inactive bulletin, How to view and update Taxonomy on the Provider Profile in NCTracks User Guide, information registered with the state of North Carolina. Sign up to get the latest information about your choice of CMS topics. All PHP systems require taxonomy codes to be submitted on all claim types except pharmacy point of sale claims. 11 GROUP # of destination payer. lock Please compare the information submitted to the information registered with information registered with the state of North Carolina. 7. 3
1. The Structure Of Taxonomy Codes. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. The Purpose of, Read More What is the taxonomy code for a home health agency?Continue, 2023 NPI Lookup Service - WordPress Theme by Kadence WP. http://www.wpc-edi.com/products/codelists/alertservice. In Application: By default, the system uses the information found under Admin > Member Info to populate Box 33b. In place of TPIs, providers will need to submit their NPI/API, taxonomy code, benefit code (if applicable), and complete address with city, state, and ZIP+4 code. CMS has created a crosswalk of taxonomy codes that links the types of providers and suppliers who are eligible to apply for enrollment in the Medicare program with the appropriate Healthcare Provider Taxonomy Codes. Taxonomy does not exist for Rendering Provider. For Medicare, Condition Code DR is reported only in the institutional claim (electronic 837I . 27 Select Yes/No of ACCEPT ASSIGNMENT under Authorization Information within Other Attributes page in Patient Master. Follow the steps described below:-. These codes define the health care service provider type, classification, and area of specialization. The NUCC has developed a 1500 Reference Instruction Manual detailing how to complete the claim form. CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). 2000A PRV01, 02, 03. Taxonomy codes will be required when submitting professional claims for all HAP and HAP Empowered business lines beginning January 1, 2020. <>
As the name itself suggests, this one is the level of specialization as it provides the specific categories of Taxonomy codes. Display Y if EMERGENCY check box is selected under Others tab in Charge Entry.