NM1

Payer Name

Pos: 050	Max: 1
Detail - Optional
Loop: 2100A	Elements: 5

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

PR

Payer

NM102

1065

Entity Type Qualifier
Description: Code qualifying the type of entity

M

ID

1/1

Required

Code

Name

2

Non-Person Entity

NM103

1035

Name Last or Organization Name
Description: Individual last name or organizational name
Industry: Payer Name

O

AN

1/35

Required

NM108

66

Identification Code Qualifier
Description: Code designating the system/method of code structure used for Identification Code (67)
Payer identifiers should be used with the following preferences:
(PI) Payer ID
(NI) NAIC Code
(AD) If the Payer is a Blue Cross or Blue Shield Plan, BCBSA Plan Code
(PP) If the Payer is a Pharmacy Processor, Pharmacy Processor Number
(FI) Tax ID
(21) If other codes are not available or known, use HIN or Payer Identification Number

C

ID

1/2

Required

Code

Name

21

Health Industry Number (HIN)

CODE SOURCE:

121: Health Industry Identification Number

AD

Blue Cross Blue Shield Association Plan Code

FI

Federal Taxpayer's Identification Number

NI

National Association of Insurance Commissioners (NAIC) Identification

PI

Payor Identification

PP

Pharmacy Processor Number

XV

Health Care Financing Administration National Payer Identification Number (PAYERID)

CODE SOURCE:

540: Health Care Financing Administration National PlanID

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Payer Identifier

C

AN

2/80

Required

ExternalCodeList

Name: 121

Description: Health Industry Identification Number

ExternalCodeList

Name: 245

Description: National Association of Insurance Commissioners (NAIC) Code">

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. Payers with multiple locations or lines of business may require.

Example:

NM1*PR*2*ABC INSURANCE*****PI*12345~