Loop 2010AB |
|
||||||
|
Pos |
Id |
Segment Name |
Req |
Max Use |
Repeat |
Usage |
|
015 |
NM1 |
Pay-to Provider’s Name |
O |
1 |
|
Situational |
|
020 |
N2 |
Additional Pay-to Provider Name Information |
O |
1 |
|
Situational |
|
025 |
N3 |
Pay-to Provider’s Address |
O |
1 |
|
Required |
|
030 |
N4 |
Pay-to Provider City/State/Zip |
O |
1 |
|
Required |
|
035 |
REF |
Pay-to Provider Secondary Identification Number |
O |
5 |
|
Situational |
1. |
NM102 qualifies NM103. |
1. |
NM110 and NM111 further define the type of entity in NM101. |
Notes: |
1. If the billing provider and the pay-to provider are the same entity, then it is not necessary to put in the pay-to-provider loop.
|
Example: |
NM1*87*1*JONES*WILLIAM****XX*0987654321~ |