NM1

Dependent Name

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

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: Dependent Last Name
Required if valued on the request.

O

AN

1/35

Situational

NM104

1036

Name First
Description: Individual first name
Industry: Dependent First Name
Required if valued on the request.

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Dependent Middle Name
Use if NM104 is valued and the middle name/initial of the dependent is known.

O

AN

1/25

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Dependent Name Suffix
Use this for the suffix of an individual’s name; 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)

C

ID

1/2

Situational

Code

Name

MI

Member Identification Number

Use this code for the payer-assigned identifier for the dependent, even if the payer calls its number a policy number, recipient number, HIC number, or some other synonym.

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 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: Dependent Primary Identifier
Alias: Dependent Member Number
Value only if the dependent has a unique member ID that is known by the UMO. Under most circumstances, this data element is not used.

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.

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~