NM1

Incorrect Member Name

Pos: 030	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

70

Prior Incorrect Insured

Use this code if correcting identifying or demographic information on a member enrolled. If only demographic information is being corrected, NM101 in Loop 2100A will be IL and the name information in NM103, NM104, NM105 will be identical in loop 2100A and this loop.

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: Prior Incorrect Insured Last Name

O

AN

1/35

Required

NM104

1036

Name First
Description: Individual first name
Industry: Prior Incorrect Insured First Name

O

AN

1/25

Required

NM105

1037

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

O

AN

1/25

Situational

NM106

1038

Name Prefix
Description: Prefix to individual name
Industry: Prior Incorrect Insured Name Prefix
Send if supplied by subscriber.

O

AN

1/10

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Prior Incorrect Insured 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: Prior Incorrect Insured Identifier
What ever identifier that was previously sent in error should be sent in this segment to allow matching with data on receiver’s system.

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 only used if a corrected name is sent in loop 2100A or if the previously supplied demographics are being changed. If only the demographics are being changed, the code in NM101 in Loop 2100A will be IL, and the code in NM101 in this loop will be 70.

Example:

NM1*70*1*SMYTH*JON~