N4

Subscriber Benefit Related City/State/ZIP Code

Pos: 370	Max: 1
Detail - Optional
Loop: 2120C	Elements: 6

Ref

Id

Element Name

Req

Type

Min/Max

Usage

N401

19

City Name
Description: Free-form text for city name
Industry: Benefit Related Entity City Name
Use this text for the city name of the entity’s address.

O

AN

2/30

Situational

N402

156

State or Province Code
Description: Code (Standard State/Province) as defined by appropriate government agency
Industry: Benefit Related Entity State Code
CODE SOURCE: 22: States and Outlying Areas of the U.S.
Use this code for the state code of the entity’s address.

O

ID

2/2

Situational

ExternalCodeList

Name: 22

Description: States and Outlying Areas of the U.S.

N403

116

Postal Code
Description: Code defining international postal zone code excluding punctuation and blanks (zip code for United States)
Industry: Benefit Related Entity Postal Zone or ZIP Code
CODE SOURCE: 51: ZIP Code
Use this code for the ZIP or Postal Code of the entity’s address.

O

ID

3/15

Situational

ExternalCodeList

Name: 51

Description: ZIP Code

N404

26

Country Code
Description: Code identifying the country
CODE SOURCE: 5: Countries, Currencies and Funds
Use this code to specify the country of the entity’s address, if other than the United States.

O

ID

2/3

Situational

ExternalCodeList

Name: 5

Description: Countries, Currencies and Funds

N405

309

Location Qualifier
Description: Code identifying type of location
Use only for CHAMPUS/TRICARE or CHAMPVA purposes.

C

ID

1/2

Situational

Code

Name

RJ

Region

Use this code only to communicate the Department of Defense Health Service Region in N406.

N406

310

Location Identifier
Description: Code which identifies a specific location
Industry: Department of Defense Health Service Region Code
Use only for CHAMPUS/TRICARE or CHAMPVA to communicate the Department of Defense Health Service Region for a Primary Care Provider.
CODE SOURCE DOD1: Military Health Systems Functional Area Manual - Data.

O

AN

1/30

Situational

ExternalCodeList

Name: DOD1

Description: Military Health Systems Functional Area
Manual - Data.

1.

C0605 - If N406 is present, then all of N405 are required

1.

A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location.

2.

N402 is required only if city name (N401) is in the U.S. or Canada.

Notes:

1. Use this segment to identify the city, state and ZIP Code for an entity.
2. Required when needed to further identify the entity or individual in loop 2120C NM1 and the information is available.

Example:

N4*NEW YORK*NY*10003~