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