Tip: Provider Specialty

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Mar 1, 2019

 Jan 20, 2023

Included in January 2023 Data Tips Email

Two types of provider specialty codes are required for the Arkansas APCD.

 1. SE-specific provider specialty codes are included in the supplemental Lookup file received as part of the data request (if medical claims are included). This file provides SE-specific provider specialty definitions for fields Service Provider Specialty (MC032) and Billing Provider Specialty (MC212). Some SEs have no custom provider specialty codes and use CMS specialty codes instead.

 2. CMS specialty codes or CMS taxonomy codes are required for PV019, PV020, AND PV021. If an SE cannot provide the CMS taxonomy code, it provides the associated 2 byte CMS specialty codes. CMS specialty codes can be found at this link: 

https://www.cms.gov/medicare/provider-enrollment-and- certification/medicareprovidersupenroll/downloads/jsmtdl-08515medicarprovidertypetohcptaxonomy.pdf

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