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 Fields
| 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 |
