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Reminder: Proper Billing for Behavioral Health Providers

July 25, 2022

To: Behavioral Health Providers

As a reminder, behavioral health providers must include the correct taxonomy and performing provider information (when applicable) on 837P and CMS 1500 claims for Legacy and Highmark system patients. Doing so ensures your claims are processed correctly.

Individual Credentialed Providers

Providers who are individually credentialed with Highmark Blue Shield of Northeastern New York must include the NPI number and taxonomy of the billing provider in the Billing Provider Loop on the 837P or in Box 33a (NPI) and Box 33b (Taxonomy, must include ‘ZZ’ qualifier) on the CMS 1500 claim form.

You must use the taxonomy code that corresponds with the specialty type of the billing provider group:

  •   Same-specialty groups (Example: all Clinical Social Workers) must use taxonomy code 1041C0700X
  • Multispecialty groups must use taxonomy code 193200000X

Additionally, individual credentialed providers must also include the NPI number AND taxonomy code of the performing provider in the Performing/Rendering Provider Loop on the 837P or Line 24J on the CMS 1500 claim form. The following provider types should bill in this manner:

  •  Certified Social Worker
  • Licensed Mental Health Counselors (LMHC) credentialed for Commercial (non-Medicare Advantage) plans ONLY
  • Psychiatrists (MD or DO)
  • Psychologists
  • Independent Psychiatric Nurse Practitioners

Providers Covered Under a Billable Group

Providers who are covered under a billable group (not individually credentialed with Highmark BSNENY) must include the NPI number of the billing provider group and taxonomy code. This information should be in the Billing Provider Loop on the 837P or in Box 33a (NPI) and Box 33b (Taxonomy, must include ‘ZZ’ qualifier) on the CMS 1500 claim form.

  •  Billable groups must use taxonomy code 101YM0800X

Please note: The Rendering Provider Loop on the 837P or Line 24J on the CMS 1500 claim form must remain BLANK. You do not need to include an NPI number or taxonomy code in this loop/field.

Additional information regarding CMS1500 fields can be found at

 For the most updated claims and billing information related to our affiliation with Highmark, please review our provider FAQs at

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