NM1

Dependent Name

Pos: 050	Max: 1
Detail - Optional
Loop: 2100E	Elements: 9

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

QC

Patient

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: Patient Last Name

O

AN

1/35

Required

NM104

1036

Name First
Description: Individual first name
Industry: Patient First Name
Always return this information when it is supplied on a claim.
Required if additional name information is needed to identify the patient.

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Patient Middle Name
Required if additional name information is needed to identify the patient.

O

AN

1/25

Situational

NM106

1038

Name Prefix
Description: Prefix to individual name
Industry: Patient Name Prefix
Required if additional name information is needed to identify the patient.

O

AN

1/10

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Patient Name Suffix
Required if additional name information is needed to identify the patient.

O

AN

1/10

Situational

NM108

66

Identification Code Qualifier
Description: Code designating the system/method of code structure used for Identification Code (67)

C

ID

1/2

Situational

Code

Name

MI

Member Identification Number

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: Patient Primary Identifier
At this level, NM108 and NM109 are required if the dependent is assigned a unique identification number that is separate from the subscriber number in HL4 (HL22).

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.

Example:

NM1*QC*1*SMITH*JOSEPH****MI*01234567802~