NM1

Individual Name

Pos: 020	Max: 1
Detail - Optional
Loop: 2100B	Elements: 9

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

EY

Employee Name

QE

Policyholder

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
Health Care Industry: Individual Last Name
This is required when the sender needs to relay the individual’s last name.

O

AN

1/35

Situational

NM104

1036

Name First
Description: Individual first name
Health Care Industry: Individual First Name
This is required when the sender needs to relay the individual’s first name.

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Health Care Industry: Individual Middle Name
This is required when the sender needs to relay the individual’s middle name.

O

AN

1/25

Situational

NM106

1038

Name Prefix
Description: Prefix to individual name
Health Care Industry: Individual Name Prefix
This is required when the sender needs to relay the individual’s name prefix.

O

AN

1/10

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Health Care Industry: Individual Name Suffix
This is required when the sender needs to relay the individual’s name suffix.

O

AN

1/10

Situational

NM108

66

Identification Code Qualifier
Description: Code designating the system/method of code structure used for Identification Code (67)
This is required when the sender needs to relay a unique identifier that is associated to the individual.

C

ID

1/2

Situational

Code

Name

N

Insured's Unique Identification Number

34

Social Security Number

EI

Employee Identification Number

NM109

67

Identification Code
Description: Code identifying a party or other code
Health Care Industry: Individual Identifier

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. This segment is used to relay the name and identifier of the individual for whom the premium payment is being submitted.

Example:

NM1*EY*1*SHEPARD*JESSICA****EI*999887777A~