NM1

Credit/Debit Card Account Holder Name

Pos: 015	Max: 1
Detail - Optional
Loop: 2010BB	Elements: 8

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
Code AO was added to this implementation guide to support credit/debit card information billing. See Appendix G, Credit/Debit Card Use, for details.

M

ID

2/3

Required

Code

Name

AO

Account Of

NM102

1065

Entity Type Qualifier
Description: Code qualifying the type of entity

M

ID

1/1

Required

Code

Name

1

Person

2

Non-Person Entity

NM103

1035

Name Last or Organization Name
Description: Individual last name or organizational name
Industry: Credit or Debit Card Holder Last or Organizational Name
Alias: Account Holder Last Name

O

AN

1/35

Required

NM104

1036

Name First
Description: Individual first name
Industry: Credit or Debit Card Holder First Name
Alias: Account Holder First Name
This data element is required when NM102 equals one (1).

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Credit or Debit Card Holder Middle Name
Alias: Account Holder Middle Initial
This data element is required when NM102 = 1 and the Middle Name or Initial of the person is known.

O

AN

1/25

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Credit or Debit Card Holder Name Suffix
This data element is required when the NM102 equals one (1) and the name suffix is known. Examples: I, II, III, IV, Jr, Sr.

O

AN

1/10

Situational

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

MI

Member Identification Number

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Credit or Debit Card Number
Alias: Credit/Debit Card Account Number

C

AN

2/80

Required

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. 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.
2. The information carried under this segment must never be sent to the payer. This information is only for use between a provider and a service organization offering patient collection services. In this case, it is the responsibility of the collection service organization to remove this segment before forwarding the claim to the payer.

Example:

NM1*AO*1*DOE*JOHN*T***MI*739004273~