NM1

Other Payer Name

Pos: 325	Max: 1
Detail - Optional
Loop: 2330B	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

PR

Payer

NM102

1065

Entity Type Qualifier
Description: Code qualifying the type of entity

M

ID

1/1

Required

Code

Name

2

Non-Person Entity

NM103

1035

Name Last or Organization Name
Description: Individual last name or organizational name
Industry: Other Payer Last or Organization Name
Alias: Other Payer Name
NSF Reference: DA0-09.0

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

PI

Payor Identification

XV

Health Care Financing Administration National Payer Identification Number (PAYERID)

CODE SOURCE:

540: Health Care Financing Administration National PlanID

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Other Payer Primary Identifier
Alias: Other Payer Primary Identification Number
NSF Reference: DA0-07.0

C

AN

2/80

Required

ExternalCodeList

Name: 540

Description: Health Care Financing Administration National PlanID

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. Submitters are required to send all known information on other payers in this loop ID-2330.

Example:

NM1*PR*2*UNION MUTUAL OF OREGON*****XV*43~