NM1

Information Receiver Name

Pos: 030	Max: 1
Detail - Optional
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 name if the entity type qualifier is a non-person entity. Otherwise, this will be the individual’s last name.
Use if available.

O

AN

1/35

Situational

NM104

1036

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

O

AN

1/25

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Information Receiver Name Suffix
Use name suffix only if available and NM102 is “1"; e.g., Sr., Jr., or III.

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 information receiver is a provider and the National Provider ID is mandated for use, code value “XX” must be used. Otherwise, one of the following codes may be used with the following hierarchy applied: Use the first code that applies: “SV”, “PP”, “FI”, “34". The code ”SV" is recommended to be used prior to the mandated use of the National Provider ID. If the information receiver is a payer and the HCFA National PlanID is mandated for use, code value “XV” must be used, otherwise, use code value “PI”. If the information receiver is an employer, use code value “24".

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 information receiver is a payer.

PP

Pharmacy Processor Number

SV

Service Provider Number

Use this code for the identification number assigned by the information source.

XV

Health Care Financing Administration National Payer Identification Number (PAYERID)

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 code for the 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

ExternalCodeList

Name: 540

Description: Health Care Financing Administration National PlanID

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, IPA, or hospital).

Example:

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