NM1

Dependent Name

Pos: 030

Max: 1

Detail - Mandatory

Loop: 2100D

Elements: 6

User Option (Usage): Required

To supply the full name of an individual or organizational entity

Element Summary:

	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
	03	Dependent

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.

1/1

Required

	Code	Name
	1	Person

NM103	1035	Name Last or Organization Name Description: Individual last name or organizational name Industry: Dependent Last Name Use this name for the dependent’s last name. Use this element 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: Dependent First Name Use this name for the dependent’s first name. Use this element 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 Industry: Dependent Middle Name Use this name for the dependent’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: Dependent 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

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. This NM1 loop is used to identify the dependent of an 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*03*1*SMITH*MARY LOU*R~