NM1

Custodial Parent

Pos: 030

Max: 1

Detail - Optional

Loop: 2100F

Elements: 9

User Option (Usage): Situational

To supply the full name of an individual or organizational entity

Element Summary:

	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
	S3	Custodial Parent

NM102

1065

Entity Type Qualifier
Description: Code qualifying the type of entity

1/1

Required

	Code	Name
	1	Person

NM103	1035	Name Last or Organization Name Description: Individual last name or organizational name Industry: Custodial Parent Last Name	O	AN	1/35	Required
NM104	1036	Name First Description: Individual first name Industry: Custodial Parent First Name	O	AN	1/25	Required
NM105	1037	Name Middle Description: Individual middle name or initial Industry: Custodial Parent Middle Name Send if supplied by subscriber.	O	AN	1/25	Situational
NM106	1038	Name Prefix Description: Prefix to individual name Industry: Custodial Parent Name Prefix Send if supplied by subscriber.	O	AN	1/10	Situational
NM107	1039	Name Suffix Description: Suffix to individual name Industry: Custodial Parent 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

Social Security Number

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

Mutually Defined

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

NM109

Identification Code
Description: Code identifying a party or other code
Industry: Custodial Parent Identifier
Send if supplied by subscriber.
The Social Security Number should be sent, when available, until the National Identifier for Individual is available.

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 loop is REQUIRED when the custodial parent of a minor dependent is someone other than the subscriber.
2. Any other situation, (examples: Guardianship, Legal Indemnity, Power of Attorney, and/or Separation Agreements) would be handled under the Responsible Party NM1 segment.

Example:

NM1*S3*1*JONES*MARY~