July 21, 2022

Wisconsin: Review taxonomy requirements for Medicaid claim submissions

We strive to process your UnitedHealthcare Community Plan claims promptly. One way you can help us do this is by including all relevant Provider information on your claims for Wisconsin Community Plan Members.

Required action
If you are a billing provider, you must include the following information on your claims and make sure it matches the current provider enrollment information on file with ForwardHealth:

  • Taxonomy Code for both billing provider and rendering provider. This is the taxonomy code registered with Wisconsin Medicaid.
  • National Provider Identification (NPI) number for both billing and rendering provider. This is the NPI registered with Wisconsin Medicaid.
  • Address with five-digit ZIP code. This is the provider's address and ZIP code with the billing provider's taxonomy and NPI number that’s registered with Wisconsin Medicaid. 

All electronic and paper claims must have a valid provider number combination that matches the provider information registered with the Wisconsin Department of Health Services (DHS) and must be submitted on the claim form. 

If you are not registered with Wisconsin Medicaid or submit claims that do not have matching information, claims will be rejected or denied. 

Potential cause for claim denial
Possible denial reasons include the following (not an all-inclusive list):

Remittance denial Reason How to correct

N255

Billing provider taxonomy missing from claim

Submit corrected claim with billing provider taxonomy

N288

Rendering provider taxonomy missing from claim

Submit corrected claim with rendering provider taxonomy

N77

Billing provider NPI does not have appropriate indicator per State

Billing provider is not registered with Wisconsin Medicaid. See how to enroll with Medicaid

N767

Rendering provider NPI does not have appropriate indicator per State

Rendering provider is not registered with Wisconsin Medicaid. See how to enroll with Medicaid

N258

Submit the correct billing address for the provider on this claim

Submit corrected claim with billing provider correct address and five-digit ZIP code registered with Wisconsin Medicaid

How to enroll with Medicaid 
If you are not already registered with Wisconsin Medicaid, you can enroll by visiting forwardhealth.wi.gov > Become a Provider > Start or Continue Your Enrollment Application. 

Questions?
For more information about the 21st Century Cures Act and about taxonomy and NPI requirements for Wisconsin Medicaid, visit Wisconsin’s ForwardHealth portal and review: 

PCA-1-22-02062-C&S-News