Appendix K Provider Type Provider Specialty Taxonomy Crosswalk – – LTX_Prov_ Specialty_ Desc LTX_Taxonomy_Desc FISCAL AGENT Disabled Agencies In Home Supportive 1 (WVR) 4A (DD) 253Z00000X Care FISCAL AGENT Agencies In Home Supportive 1 (WVR) 6H LaPOP 253Z00000X Care Respiratory, Developmental, TRANSITION Rehabilitative and Restorative SUPPORT Disabled Service Providers Rehabilitation 2 (WVR) 4A (DD) 225C00000X Counselor CHILDRENS Children's CHOICE Choice Behavioral Health & Social 3 (WVR)(IN-ST) 9E Waiver 101Y00000X Service Providers Counselor Ambulatory Health Care PEDI DAY Pediatric Facilities Clinic/Center Medically HLTH CARE Day Health Fragile Infants and Children Day 4 (IN-ST) 1Z Care 261QM3000X Care CCN-P MANAGED Care CARE ORG - Network, Managed Care Organizations 5 PREPAID 5Q Pre-paid) 302R00000X Health Maintenance Organization Nursing Service Providers Registered Nurse NOW PROFESSION 6 SERVICES 4B NOW RN 163W00000X NOW Physician Assistants & Advanced Practice Nursing Providers/Nurse 6 SERVICES 4C NOW LPN 363L00000X Practitioner NOW NOW Behavioral Health & Social 6 AL SERVICES 4D Psychologist 103T00000X Service Providers/Psychologist NOW NOW Social Behavioral Health & Social 6 SERVICES 4E Worker 104100000X Service Providers Social Worker
Appendix K Provider Type – Provider Specialty – Taxonomy Crosswalk LTX_Prov_ Specialty_ Desc LTX_Taxonomy_Desc 1 FISCAL AGENT (WVR) 4A Disabled (DD) 253Z00000X Agencies In Home Supportive Care 1 FISCAL AGENT (WVR) 6H LaPOP 253Z00000X Agencies In Home Supportive Care 2 SUPPORT (WVR) 4A Disabled (DD) 225C00000X Respiratory, Developmental, Rehabilitative and Restorative Service Providers Rehabilitation Counselor 3 CHILDRENS CHOICE (WVR)(IN-ST) 9E Children's Choice Waiver 101Y00000X Behavioral Health & Social Service Providers Counselor 4 PEDI DAY HLTH CARE (IN-ST) 1Z Pediatric Day Health Care 261QM3000X Ambulatory Health Care Facilities Clinic/Center Medically Fragile Infants and Children Day Care 5 MANAGED CARE ORG - PREPAID 5Q CCN-P Care Network, Pre-paid) 302R00000X Managed Care Organizations Health Maintenance Organization 6 NOW SERVICES 4B NOW RN 163W00000X Nursing Service Providers Registered Nurse 6 NOW SERVICES 4C NOW LPN 363L00000X Physician Assistants & Advanced Practice Nursing Providers/Nurse Practitioner 6 NOW SERVICES 4D NOW Psychologist 103T00000X Behavioral Health & Social Service Providers/Psychologist 6 NOW SERVICES 4E NOW Social Worker 104100000X Behavioral Health & Social Service Providers Social Worker TRANSITION PROFESSION AL
PIHP_CSoC_SystemsCompanionGuide-Sept2018_V12.docx