NM1

Member Name

Pos: 030	Max: 1
Detail - Optional
Loop: 2100A	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

74

Corrected Insured

Use this code if this transmission is correcting the identifier information on a member already enrolled. Usage of this code requires the sending of an NM1 with code ’70’ in loop 2100B.

IL

Insured or Subscriber

Use this code for enrolling a new member or updating a member with no change in identifying information. The identifying information for a member is specified under the insurance contract between the sponsor and payer.

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: Subscriber Last Name

O

AN

1/35

Required

NM104

1036

Name First
Description: Individual first name
Industry: Subscriber First Name

O

AN

1/25

Required

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Subscriber Middle Name
Send if supplied by subscriber.

O

AN

1/25

Situational

NM106

1038

Name Prefix
Description: Prefix to individual name
Industry: Subscriber Name Prefix
Send if supplied by subscriber.

O

AN

1/10

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Subscriber Name Suffix
Send if supplied by subscriber.

O

AN

1/10

Situational

NM108

66

Identification Code Qualifier
Description: Code designating the system/method of code structure used for Identification Code (67)
Send when required by X12 syntax.

C

ID

1/2

Situational

Code

Name

34

Social Security Number

The social security number may not be used for any Federally administered programs such as Medicare or CHAMPUS.

ZZ

Mutually Defined

Value is required if National Individual Identifier is mandated for use. Otherwise, one of the other listed codes may be used.

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Subscriber Identifier
Until the the HIPAA Individual Identifier is available the SSN is to be sent when available and allowed under confidentiality regulations.

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. REQUIRED when enrolling a new member, changing a member’s demographic information, or terminating a member.

Example:

NM1*IL*1*SMITH*JOHN*M**SR~