NM1

Subscriber Name

Pos: 030	Max: 1
Detail - Mandatory
Loop: 2100C	Elements: 8

Ref

Id

Element Name

Req

Type

Min/Max

Usage

NM101

98

Entity Identifier Code
Description: Code identifying an organizational entity, a physical location, property or an individual

M

ID

2/3

Required

Code

Name

IL

Insured or Subscriber

NM102

1065

Entity Type Qualifier
Description: Code qualifying the type of entity
Use this code to indicate whether the entity is an individual person or an organization.

M

ID

1/1

Required

Code

Name

1

Person

NM103

1035

Name Last or Organization Name
Description: Individual last name or organizational name
Industry: Subscriber Last Name
Use this name for the subscriber’s last name.
Use this name if the subscriber is the patient and if utilizing the HIPAA search option. See Section 1.3.8 for more information.

O

AN

1/35

Situational

NM104

1036

Name First
Description: Individual first name
Industry: Subscriber First Name
Use this name for the subscriber’s first name.
Use this name if the subscriber is the patient and if utilizing the HIPAA search option. See Section 1.3.8 for more information.

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Use this name for the subscriber’s middle name or initial. Use if information is known and will assist in identification of the person named, particularly when not utilizing the HIPAA search option.

O

AN

1/25

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Subscriber Name Suffix
Use this for the suffix to an individual’s name; e.g., Sr., Jr. or III. Use if information is known and will assist in identification of the person named, particularly when not utilizing the HIPAA search option.

O

AN

1/10

Situational

NM108

66

Identification Code Qualifier
Description: Code designating the system/method of code structure used for Identification Code (67)
Use this element to qualify the identification number submitted in NM109. This is the primary number that the information source associates with the subscriber.
Use this element if utilizing the HIPAA search option. See Section 1.3.8 for more information.

C

ID

1/2

Situational

Code

Name

MI

Member Identification Number

This code may only be used prior to the mandated use of code “ZZ”. This is the unique number the payer or information source uses to identify the insured (e.g., Health Insurance Claim Number, Medicaid Recipient ID Number, HMO Member ID, etc.).

ZZ

Mutually Defined

The value ‘ZZ’, when used in this data element shall be defined as “HIPAA Individual Identifier” once this identifier has been adopted. Under the Health Insurance Portability and Accountability Act of 1996, the Secretary of the Department of Health and Human Services must adopt a standard individual identifier for use in this transaction.

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Subscriber Primary Identifier
Use this reference number as qualified by the preceding data element (NM108).
Use this element if utilizing the HIPAA search option. See Section 1.3.8 for more information.

C

AN

2/80

Situational

1.

P0809 - If either NM108,NM109 is present, then all are required

2.

C1110 - If NM111 is present, then all of NM110 are required

1.

NM102 qualifies NM103.

1.

NM110 and NM111 further define the type of entity in NM101.

Notes:

1. Use this segment to identify an entity by name and/or identification number. Use this NM1 loop to identify the insured or subscriber.
2. Please refer to Section 1.3.8 Search Options for specific information about how to identify an individual to an Information Source.

Example:

NM1*IL*1*SMITH*JOHN*L***34*444115555~