NM1

Utilization Management Organization (UMO) Name

Pos: 170	Max: 1
Detail - Optional
Loop: 2010A	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

X3

Utilization Management Organization

NM102

1065

Entity Type Qualifier
Description: Code qualifying the type of entity

M

ID

1/1

Required

Code

Name

1

Person

Use this code only if the reviewing entity is an individual, such as an individual primary care physician.

2

Non-Person Entity

NM103

1035

Name Last or Organization Name
Description: Individual last name or organizational name
Industry: Utilization Management Organization (UMO) Last or Organization Name
Use if name information is needed to identify the UMO.

O

AN

1/35

Not recommended

NM104

1036

Name First
Description: Individual first name
Industry: Utilization Management Organization (UMO) First Name
Use if NM103 is valued and the reviewing entity is an individual (NM102 = 1), such as a primary care provider.

O

AN

1/25

Not recommended

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Utilization Management Organization (UMO) Middle Name
Use if NM104 is present and the middle name/initial of the person is known.

O

AN

1/25

Not recommended

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Utilization Management Organization (UMO) Name Suffix
Use this for the suffix of an individual’s name; e.g., Sr., Jr., or III.

O

AN

1/10

Not recommended

NM108

66

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

C

ID

1/2

Required

Code

Name

24

Employer's Identification Number

34

Social Security Number

46

Electronic Transmitter Identification Number (ETIN)

PI

Payor Identification

Use until the National PlanID is mandated if the UMO is a payer.

XV

Health Care Financing Administration National Payer Identification Number (PAYERID)

Use if the UMO is a payer.

CODE SOURCE:

540: Health Care Financing Administration National PlanID

XX

Health Care Financing Administration National Provider Identifier

Use if the UMO is a provider.

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Utilization Management Organization (UMO) Identifier

C

AN

2/80

Required

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 NM1 loop to identify the source of information. In the case of a request transaction, the source of information would normally be the payer or utilization review organization making the decision on the request.

Example:

NM1*X3*2*ABC PAYER*****46*123450000~