Loop 2010DA

Pos: 170	Repeat: 1
Optional
Loop: 2010DA	Elements: N/A

Pos

Id

Segment Name

Req

Max Use

Repeat

Usage

170

NM1

Dependent Name

O

1

Required

180

REF

Dependent Supplemental Identification

O

3

Situational

230

AAA

Dependent Request Validation

O

9

Situational

250

DMG

Dependent Demographic Information

O

1

Situational

260

INS

Dependent Relationship

O

1

Situational

1.

NM102 qualifies NM103.

1.

NM110 and NM111 further define the type of entity in NM101.

Notes:

1. Use this segment to convey the name of the dependent who is the patient.
2. NM108 and NM109 are situational on the response but Not Used on the request. This enables the UMO to return a unique member ID for the dependent that was not known to the requester at the time of the request. Normally, if the dependent has a unique member ID, Loop 2000D is not used.

Example:

NM1*QC*1*SMITH*MARY~