N4

Premium Payer's City, State, Zip

Pos: 100	Max: 1
Heading - Optional
Loop: 1000B	Elements: 4

Ref

Id

Element Name

Req

Type

Min/Max

Usage

N401

19

City Name
Description: Free-form text for city name
Health Care Industry: Premium Payer City Name

O

AN

2/30

Required

N402

156

State or Province Code
Description: Code (Standard State/Province) as defined by appropriate government agency
Health Care Industry: Premium Payer State Code
CODE SOURCE: 22: States and Outlying Areas of the U.S.

O

ID

2/2

Required

ExternalCodeList

Name: 22

Description: States and Outlying Areas of the U.S.

N403

116

Postal Code
Description: Code defining international postal zone code excluding punctuation and blanks (zip code for United States)
Health Care Industry: Premium Payer Postal Zone or ZIP Code
CODE SOURCE: 51: ZIP Code

O

ID

3/15

Required

ExternalCodeList

Name: 51

Description: ZIP Code

N404

26

Country Code
Description: Code identifying the country
CODE SOURCE: 5: Countries, Currencies and Funds
This is required when the address is outside the US.

O

ID

2/3

Situational

ExternalCodeList

Name: 5

Description: Countries, Currencies and Funds

1.

C0605 - If N406 is present, then all of N405 are required

1.

A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location.

2.

N402 is required only if city name (N401) is in the U.S. or Canada.

Notes:

1. This segment is used to relay the premium payer’s city, state and zip.
2. This is required when the Premium Payer’s city, state, zip needs to be printed on the check.
3. For EFT payments this segment is not used.

Example:

N4*HARTFORD*CT*06120~