NM1

Pay-to Provider Name

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

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

1

Person

If Person is used and if the pay-to provider is the same person as the rendering provider, it is not necessary to use the Rendering Provider NM1 loop at the claim loop (Loop ID-2300).

2

Non-Person Entity

If Non-Person Entity is used then the rendering provider NM1 loop (Loop ID-2310B) must be used when appropriate to identify the person who rendered the services.

NM103

1035

Name Last or Organization Name
Description: Individual last name or organizational name
Industry: Pay-to Provider Last or Organizational Name
NSF Reference: BA0-18.0 or BA0-19.0

O

AN

1/35

Required

NM104

1036

Name First
Description: Individual first name
Industry: Pay-to Provider First Name
NSF Reference: BA0-20.0
Required if NM102=1 (person).

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Pay-to Provider Middle Name
NSF Reference: BA0-21.0
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: Pay-to Provider Name Suffix
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 or the Social Security 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

The social security number may not be used for Medicare.

XX

Health Care Financing Administration National Provider Identifier

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Pay-to Provider Identifier
Alias: Pay-to Provider Primary Identification Number
NSF Reference: BA0-09.0, CA0-28.0, BA0-02.0, BA1-02.0, YA0-02.0, BA0-06.0, BA0-10. 0, BA0-12.0, BA0-13.0, BA0-14.0, BA0-15.0, BA0-16.0, BA0-17.0, BA0-24.0, 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. 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 syntax rules.

Example:

NM1*87*1*CRAMMER*JOSEPH****XX*09876543~