The CMS-1500 form does not have one box labeled “provider type.” Instead, it uses several fields to identify the people and organizations involved in the claim.
Common provider roles
- Billing provider: The individual or organization submitting the claim, generally shown in Box 33.
- Rendering provider: The person who performed the service, commonly identified in Box 24J.
- Referring or ordering provider: Reported when the service or payer rules require that relationship.
- Service facility: The location where the service was rendered when different from the billing provider location.
NPI and taxonomy information
NPIs identify provider records. A taxonomy code may be requested by a payer to describe a provider’s classification or specialization. Do not assume taxonomy is always required in Box 33b; follow the NUCC instructions and the payer’s companion guidance.
Billing reminder: Payer and program requirements vary. Confirm the current instructions for the payer receiving the claim.