NM1

Information Source Name

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

2B

Third-Party Administrator

36

Employer

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 Source Last or Organization Name
Use this name for the organization name if NM102 is “2". 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 Source 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 Source 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 Source 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 code value “XV” if the Information Source is a Payer and the National PlanID is mandated for use. Use code value “XX” if the information source is a provider and the HCFA National Provider Identifier is mandated for use. Otherwise one of the other appropriate code values may be used.

C

ID

1/2

Required

Code

Name

24

Employer's Identification Number

46

Electronic Transmitter Identification Number (ETIN)

FI

Federal Taxpayer's Identification Number

NI

National Association of Insurance Commissioners (NAIC) Identification

PI

Payor Identification

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

NM109

67

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

C

AN

2/80

Required

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 the eligibility or benefit information source (e.g., insurance company, HMO, IPA, employer).

Example:

NM1*PR*2*ACE INSURANCE COMPANY*****PI*87728~