Electronic & Paper Submission Edits – Taxonomy and Physical Address Required

When submitting claims, ensure claims are submitted with the appropriate Taxonomy Number and a physical address. The below charts will assist you in submitting the necessary information correctly. The taxonomy code submitted must match the one submitted and approved by the State Medicaid Agency for the submitted NPI / API.

Taxonomy Code Claim Submissions Required Field

BCBSTX Medicaid STAR/CHIP & STAR Kids Claim Requirements Electronic Claims CMS-1500
Claim Form
UB-04
Form Locator
Billing Provider Taxonomy Code – required on all claims 2000A, PRV03 Box 33b
w/ ZZ qualifier preceding the taxonomy code
Box 81cc A
w/ B3 qualifier
Rendering Provider Taxonomy Code – required on Professional claims when Rendering Provider information is submitted at the claim and/or service line level 2310B, PRV03 (claim level)
2420A, PRV03 (service line level)
Box 24J shaded area
w/ ZZ qualifier in Box 24I
N/A
Attending Provider Taxonomy Code - required on Inpatient Institutional claims 2310A, PRV03 N/A Box 76
w/ B3 qualifier

NPI and Physical Address Claim Submission Requirements

BCBSTX Medicaid STAR/CHIP & STAR Kids Claim Requirements Electronic Claims CMS-1500
Claim Form
UB-04
Form Locator
Atypical Providers – If NPI is not submitted, provider must submit their assigned API number Billing Provider Secondary Identification Loop
2010BB, REF01 (G2 qualifier)
2010BB, REF02 (API Number)
Box 19
w/G2 qualifier followed by API Number
Box 57
w/G2 qualifier followed by API Number
Billing Provider NPI – required on all claims (excluding Atypical Providers) 2010AA, NM109 Box 33a Box 56
Rendering Provider NPI – required on Professional claims when the Rendering Provider is different from the Billing Provider 2310B, NM109 (claim level)
2420A, NM109 (service line level)
Box 24J
Unshaded area
N/A
Attending Provider NPI – required on Inpatient Institutional claims 2310A, NM109 N/A Box 76
Billing Provider Address – required on all claims. Should contain the physical address, not a PO Box or Lock Box 2010AA, N301/N302 Box 33 Box 1