N1

TPA/Broker Name

Pos: 070	Max: 1
Heading - Optional
Loop: 1000C	Elements: 4

Ref

Id

Element Name

Req

Type

Min/Max

Usage

N101

98

Entity Identifier Code
Description: Code identifying an organizational entity, a physical location, property or an individual

M

ID

2/3

Required

Code

Name

BO

Broker or Sales Office

TV

Third Party Administrator (TPA)

N102

93

Name
Description: Free-form name
Industry: TPA or Broker Name

C

AN

1/60

Required

N103

66

Identification Code Qualifier
Description: Code designating the system/method of code structure used for Identification Code (67)

C

ID

1/2

Required

Code

Name

94

Code assigned by the organization that is the ultimate destination of the transaction set

FI

Federal Taxpayer's Identification Number

XV

Health Care Financing Administration National Payer Identification Number (PAYERID)

CODE SOURCE:

540: Health Care Financing Administration National PlanID

N104

67

Identification Code
Description: Code identifying a party or other code
Industry: TPA or Broker Identification Code

C

AN

2/80

Required

ExternalCodeList

Name: 540

Description: Health Care Financing Administration National PlanID

1.

R0203 - At least one of N102,N103 is required

2.

P0304 - If either N103,N104 is present, then all are required

1.

This segment, used alone, provides the most efficient method of providing organizational identification. To obtain this efficiency the "ID Code" (N104) must provide a key to the table maintained by the transaction processing party.

2.

N105 and N106 further define the type of entity in N101.

Notes:

1. This loop should be sent if a TPA/broker is involved.
2. This loop is REQUIRED when a TPA or a Broker is involved. See section 1.3 for definitions.

Example:

N1*TV**FI*123356799~