NM1

Crossover Carrier Name

Pos: 030

Max: 1

Detail - Optional

Loop: 2100

Elements: 5

	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

NM102

1065

Entity Type Qualifier
Description: Code qualifying the type of entity

1/1

Required

	Code	Name
	2	Non-Person Entity

	NM103	1035	Name Last or Organization Name Description: Individual last name or organizational name Industry: Coordination of Benefits Carrier Name Name of the crossover carrier associated with this claim.	O	AN	1/35	Required
	NM108	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

Blue Cross Blue Shield Association Plan Code

Federal Taxpayer's Identification Number

National Association of Insurance Commissioners (NAIC) Identification

ADVISED

Payor Identification

Pharmacy Processor Number

Health Care Financing Administration National Payer Identification Number (PAYERID)

ADVISED

CODE SOURCE:

540: Health Care Financing Administration National PlanID

NM109

Identification Code
Description: Code identifying a party or other code
Industry: Coordination of Benefits Carrier Identifier

2/80

Required

	ExternalCodeList
	Name: 245
	Description: National Association of Insurance Commissioners (NAIC) Code

	ExternalCodeList
	Name: 540
	Description: Health Care Financing Administration National PlanID

Notes:

1. Use this NM1 segment to provide information about the crossover carrier. Provide any reference numbers in NM109. The crossover carrier is defined as any payer to which the claim is transferred for further payment after being finalized by the current payer.

Example:

NM1*TT*2*ACME INSURANCE*****XV*123456789~

1.	P0809 - If either NM108,NM109 is present, then all are required
2.	C1110 - If NM111 is present, then all of NM110 are required