NM1

Dependent Benefit Related Entity Name

Pos: 340	Max: 1
Detail - Optional
Loop: 2120D	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

13

Contracted Service Provider

1P

Provider

2B

Third-Party Administrator

36

Employer

73

Other Physician

FA

Facility

GP

Gateway Provider

IL

Insured or Subscriber

Use if identifying an insured or subscriber to a plan other than the information source (such as in a co-ordination of benefits situation).

LR

Legal Representative

P3

Primary Care Provider

P4

Prior Insurance Carrier

P5

Plan Sponsor

PR

Payer

VN

Vendor

X3

Utilization Management Organization

PRP

Primary Payer

SEP

Secondary Payer

TTP

Tertiary 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: Benefit Related Entity 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: Benefit Related Entity 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: Benefit Related Entity 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: Benefit Related Entity 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)
If the entity being identified is a provider and the National Provider ID is mandated for use, code value “XX” must be used, otherwise, one of the other codes may be used. If the entity being identified is a payer and the HCFA National PlanID is mandated for use, code value “XV” must be used, otherwise, one of the other codes may be used. If the entity being identified is an individual, the “HIPAA Individual Identifier” must be used once this identifier has been adopted, otherwise, one of the other codes may be used.
Required when available.

C

ID

1/2

Situational

Code

Name

24

Employer's Identification Number

34

Social Security Number

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

46

Electronic Transmitter Identification Number (ETIN)

FA

Facility Identification

FI

Federal Taxpayer's Identification Number

MI

Member Identification Number

Use this code to identify the entity’s Member Identification Number associated with a payer other than the information source in Loop 2100A. This code may only be used prior to the mandated use of code “ZZ”.

NI

National Association of Insurance Commissioners (NAIC) Identification

PI

Payor Identification

PP

Pharmacy Processor Number

SV

Service Provider Number

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

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

C

AN

2/80

Situational

ExternalCodeList

Name: 245

Description: National Association of Insurance Commissioners (NAIC) Code

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 a provider (such as the primary care provider), an individual, another payer, or another information source when applicable to the eligibility response.

Example:

NM1*P3*1*JONES*MARCUS***MD*SV*111223333~