NM1

Information Receiver Name

Pos: 030	Max: 1
Detail - Mandatory
Loop: 2100B	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

1P

Provider

2B

Third-Party Administrator

36

Employer

80

Hospital

FA

Facility

GP

Gateway Provider

P5

Plan Sponsor

PR

Payer

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

2

Non-Person Entity

NM103

1035

Name Last or Organization Name
Description: Individual last name or organizational name
Industry: Information Receiver Last or Organization Name
Use this name for the organization's name if the entity type qualifier is a non-person entity. Otherwise, use this name for the individual's last name. Use if name information is needed to identify the receiver of eligibility or benefit information.

O

AN

1/35

Situational

NM104

1036

Name First
Description: Individual first name
Industry: Information Receiver First Name
Use this name only if NM102 is "1".

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Information Receiver Middle Name
Use this name only if NM102 is "1".

O

AN

1/25

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Information Receiver Name Suffix
Use this for the suffix to an individual's name; e.g., Sr., Jr. or III.
Use this only if NM102 is "1".

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 number that the information source associates with the information receiver. Because only one number can be submitted in NM109, the following hierarchy must be used. Additional identifiers are to be placed in the REF segment. If the National Provider ID is mandated for use, use code value "XX". Otherwise one of the other code values may be used. If another code value is used, the following hierarchy must be applied: Use the first code that applies: "SV", "PP", "FI", "34", "24", "PI". The code "SV" is recommended to be used prior to the mandated of use of National Provider ID.

C

ID

1/2

Required

Code

Name

24

Employer's Identification Number

Use this code only when the 270/271 transaction sets are used by an employer inquiring about eligibility and benefits of their employees.

34

Social Security Number

The social security number may not be used for any Federally administered programs such as Medicare.

FI

Federal Taxpayer's Identification Number

PI

Payor Identification

Use this code only when the 270/271 transaction sets are used between two payers.

PP

Pharmacy Processor Number

SV

Service Provider Number

Use this code for the identification number assigned by the information source to be used by the information receiver in health care transactions.

XV

Health Care Financing Administration National Payer Identification Number (PAYERID)

Required if the National PlanID is mandated for use. Otherwise, one of the other listed codes may be used.

CODE SOURCE:

540: Health Care Financing Administration National PlanID

XX

Health Care Financing Administration National Provider Identifier

See code source 537.

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Information Receiver Identification Number
Use this reference number as qualified by the preceding data element (NM108).

C

AN

2/80

Required

ExternalCodeList

Name: 537

Description: Health Care Financing Administration National Provider Identifier

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. This NM1 loop is used to identify the eligibility/benefit information receiver (e.g., provider, medical group, employer, IPA, or hospital).

Example:

NM1*1P*1*JONES*MARCUS***MD*34*111223333~