Medicare AdvantageAdministrativeHigh impact
Special Alert December 2025 - Taxonomy Requirements
Providence Health Plan·OR·Provider News
Effective date
Mar 15, 2026
We identified it
Sep 2, 2026
Summary
Effective March 15, 2026, Providence Health Plan (PHP) and Providence Health Assurance (PHA) will require taxonomy codes on all provider-submitted Medicare and Commercial claims. Claims submitted with missing or incorrect taxonomy codes will be denied. Providers must ensure their taxonomy codes are accurately registered with CMS and included in all claim submissions.
Action Required
By March 15, 2026: (1) Billing team must verify that all provider taxonomy codes are correctly registered with CMS using the CMS taxonomy code lookup tool; (2) Update billing software and claim submission systems to require and validate taxonomy codes on all claims submitted to PHP and PHA; (3) Configure system to reject or flag claims with missing or incorrect taxonomy codes before submission; (4) Providers must ensure their taxonomy codes are accurate and up-to-date in the billing system and match their credentials; (5) Test claim submission process with correct taxonomy codes to ensure compliance. Failure to include valid taxonomy codes will result in claim denials and lost revenue.