NM1

Pay-To Provider Name

Pos: 015	Max: 1
Detail - Optional
Loop: 2010AB	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

Code

Name

87

Pay-to Provider

NM102

1065

Entity Type Qualifier
Description: Code qualifying the type of entity

M

ID

1/1

Required

Code

Name

2

Non-Person Entity

If this entity is the Service Facility Provider, it is not necessary to use the Service Facility Provider NM1 loop, loop 2310D.

NM103

1035

Name Last or Organization Name
Description: Individual last name or organizational name
Industry: Pay-to Provider Last or Organizational Name
Alias: Pay-to Provider Last Name or Organizational Name

O

AN

1/35

Required

NM108

66

Identification Code Qualifier
Description: Code designating the system/method of code structure used for Identification Code (67)
If “code XX - NPI” is used in the NM108/09 of this loop, then either the Employer’s Identification Number or the Social Security Number of the provider must be carried in this REF. The number sent is the one which is used on the 1099. If additional numbers are needed the REF can be run up to 5 times.

C

ID

1/2

Required

Code

Name

24

Employer's Identification Number

34

Social Security Number

The social security number may not be used for Medicare.

XX

Health Care Financing Administration National Provider Identifier

Description: Required value if the National Provider ID 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: Pay-to Provider Identifier
Alias: Pay-to Provider Primary Identification Number

C

AN

2/80

Required

ExternalCodeList

Name: 537

Description: Health Care Financing Administration National Provider Identifier

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 if the Pay-to Provider is a different entity than the Billing Provider.
2. Because the usage of this segment is “Situational” this is not a syntactically required loop. If this loop is used, then this segment is a “Required” segment. See Appendix A for further details on ASC X12 nomenclature.

Example:

NM1*87*2*ELLIS HOSPITAL*****24*123456789~