NM1

Billing Provider Name

Pos: 015	Max: 1
Detail - Optional
Loop: 2010AA	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
Use this code to indicate billing provider, billing submitter and encounter reporting entity.

M

ID

2/3

Required

Code

Name

85

Billing Provider

Use this code when the provider is a submitting provider in a capitated environment.

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: Billing Provider Last or Organizational Name
Alias: Billing Provider Name

O

AN

1/35

Required

NM104

1036

Name First
Description: Individual first name
Industry: Billing Provider First Name
Alias: Billing Provider Name
Required if NM102 = 1 (person).

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Billing Provider Middle Name
Alias: Billing Provider Name
Required if NM102 = 1 and the middle name/initial of the person is known.

O

AN

1/25

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Billing Provider Name Suffix
Alias: Billing Provider Name
Required if known.

O

AN

1/10

Situational

NM108

66

Identification Code Qualifier
Description: Code designating the system/method of code structure used for Identification Code (67)
If “XX - NPI” is used, then either the Employer’s Identification Number, Social Security Number or Federal Tax Identification Number of the Provider must be carried in the REF in this loop.

C

ID

1/2

Required

Code

Name

24

Employer's Identification Number

34

Social Security Number

XX

Health Care Financing Administration National Provider Identifier

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Billing Provider Identifier
Alias: Billing Provider’s Primary Identification Number
NSF Reference: BA0-02.0, BA0-06.0, BA0-09.0, BA1-02.0, YA0-02.0, YA0-06.0

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. Although the name of this loop/segment is “Billing Provider” the loop/segment really identifies the billing entity. The billing entity does not have to be a health care provider to use the loop. However, some payers do not accept claims from non-provider billing entities.
2. Because this is a required segment, this is a required loop. See Appendix A for further details on ASC X12 nomenclature X12 syntax rules.

Example:

NM1*85*2*DENTAL ASSOCIATES*****34*123456789~