NM1

Additional Patient Information Contact Name

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

1P

Provider

2B

Third-Party Administrator

FA

Facility

PR

Payer

X3

Utilization Management Organization

ABG

Organization

Use when the destination is an entity other than those listed.

NM102

1065

Entity Type Qualifier
Description: Code qualifying the type of entity

M

ID

1/1

Required

Code

Name

1

Person

Use this name only if the destination 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: Response Contact Last or Organization Name
Required if the responder needs to identify the destination by name.

O

AN

1/35

Situational

NM104

1036

Name First
Description: Individual first name
Industry: Response Contact First Name
Use if NM103 is valued and the destination is an individual (NM102 = 1), such as a primary care provider.

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Response Contact Middle Name
Use if NM104 is present and the middle name/initial of the person is known.

O

AN

1/25

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Response Contact 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)
Required if the responder needs to use an identifier to identify the destination.

X

ID

1/2

Situational

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 destination is a payer.

XV

Health Care Financing Administration National Payer Identification Number (PAYERID)

Use if the destination is a payer.

CODE SOURCE:

540: Health Care Financing Administration National PlanID

XX

Health Care Financing Administration National Provider Identifier

Use if the destination is a provider.

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Response Contact Identifier
Required if NM108 is used.

X

AN

2/80

Situational

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 destination location to route the response for the requested additional patient information.
2. Use this NM1 loop only if
a. the response contains a request for additional patient information in loop 2000D
b. the destination for the response to the request for additional patient information differs from the information specified in the UMO Name NM1 loop (Loop 2010A)
c. the request for additional patient information is not transmitted in another X12 functional group
3. Because the usage of this segment is “Situational” this is not a syntactically required loop. If this loop is used, then this segment is a “Required” segment. See Appendix A for further details on ASC X12 syntax rules.
Refer to Section 2.2.5 for more information on this NM1 loop.

Example:

NM1*2B*2*ACME THIRD PARTY ADMINISTRATOR~