NM1

Dependent Name

Pos: 030	Max: 1
Detail - Optional
Loop: 2100D	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

03

Dependent

NM102

1065

Entity Type Qualifier
Description: Code qualifying the type of entity

M

ID

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.
Required unless a rejection response is generated and this element was not valued in the request.

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.
Required unless a rejection response is generated and this element was not valued in the request.

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.
Required if this is availalble from the Information Source’s database unless a rejection response is generated and this element was not valued in the request.

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 available.

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 dependent.
Prior to the mandated use of the HIPAA Unique Patient Identifier, the Member Identification Number for the dependent will be returned if the information source has assigned a unique identifier for the dependent. Subsequent 270 requests should contain this Member Identification Number and the dependent would then be submitted as the subscriber.
Required when available.

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: Dependent Primary Identifier
Use this code for the reference number as qualified by the preceding data element (NM108).
Required when available.

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. This NM1 loop is used to identify the dependent of an insured or subscriber.

Example:

NM1*03*1*SMITH*JOHN*L**JR*MI*444115555~