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September 2025 Top of Mind
Rendering provider NPI & taxonomy will be required on all Commercial claims in 2026
Informational edits will alert you to missing information beginning in October
It’s never fun to have a claim rejected or denied — it creates more work to figure out what’s wrong and then submit a corrected claim. That means time away from helping your patients and delays in getting to your other administrative tasks. Most importantly, it means a longer wait for reimbursement.
To avoid these issues, Optum Behavioral Health is giving you advance notice to prepare for an upcoming change in Commercial billing requirements. Here’s what you need to know:
What’s changing: Beginning in 2026, all behavioral health claims for members covered by a Commercial (employer-sponsored) health plan must include the National Provider Identifier (NPI) and taxonomy code(s) for both the billing provider and the rendering provider. Claims that are missing this information will be rejected or denied.
The NPI and taxonomy will also be validated against the National Plan and Provider Enumeration System (NPPES).
When is this effective: The effective date will be announced in Q1 2026 and will have an advance notification period. We’re announcing this change now so that there’s ample time for billing processes to be updated. We encourage all providers to adjust their submission processes well ahead of the effective date.
- Why this is being required now: Federal regulations already require this information on claim submissions. Recent updates on Optum claim platforms now allow us to check claims against the requirement.
FYI – Informational edits begin in October
To help you prepare for this change and alert you to potential issues, Optum Behavioral Health will begin informally monitoring claim submissions in October. Claims that are submitted without the rendering provider NPI and taxonomy, or have it placed in the wrong spot, will be marked with an informational edit to remind you that the fields are required in 2026. The edit is for awareness only – 2025 claims will still be eligible for payment if the information is missing – so that you adjust processes by 2026.
Where to put NPI and taxonomy information
Rendering provider information is required when it’s different from the billing provider. Be sure to put the information in the appropriate spot on a claim:
- Electronic claims: The NPI and taxonomy are submitted in the 2310 and 2420 loops of either EDI 837P (Professional) or EDI 837I (Institutional)
- Payer ID: 87726
- Electronic Remittance Advice Payer ID: 86047
- Paper claims: Where NPI and taxonomy information is placed depends on the type of claim submitted
- Professional: Boxes 24J and 24I
- Institutional: Boxes 76 and 81
Questions?
Contact your Provider Relations Advocate.
| Key Terms & Definitions | |
|---|---|
| Rendering provider (Attending/Institutional) | The provider who delivers direct member care (such as a licensed clinical social worker, psychiatrist, licensed marriage and family therapist). An individual rendering provider must be listed on claims for services that involve direct patient care. A group/organizational billing provider cannot bill for clinical services without specifying who performed them.
|
| Billing provider | The entity or organization responsible for submitting claims (e.g., individual provider, group practice, facility, third-party billing service).
|
| National Provider Identifier (NPI) | A unique 10-digit number assigned to healthcare providers for identification in billing. There are individual and group NPIs, and the NPIs are linked to the appropriate taxonomy/specialties.
|
| Taxonomy | A unique 10-character code that designates a provider's classification and specialization. Taxonomies are associated with NPI’s. Providers must identify the relevant taxonomy code for the services provided. |
