NM1

Responsible Party Name

Pos: 015	Max: 1
Detail - Optional
Loop: 2010BC	Elements: 6

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
NSF Reference: CA0-25.0

M

ID

2/3

Required

Code

Name

QD

Responsible Party

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: Responsible Party Last or Organization Name
NSF Reference: CB0-04.0

O

AN

1/35

Required

NM104

1036

Name First
Description: Individual first name
Industry: Responsible Party First Name
NSF Reference: CB0-05.0
Required if NM102=1 (person).

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Responsible Party Middle Name
NSF Reference: CB0-06.0
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: Responsible Party Suffix Name
Alias: Responsible Party Generation
Required if known.

O

AN

1/10

Situational

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. In general terms, the responsible party is someone who is not the subscriber/patient but who has financial responsibility for the bill.
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.
3. Required for Medicare claims where there is a representative but the provider of medical services has neither the responsible party’s signature nor the patient’s signature on file.
When a Medicare beneficiary is unable to execute a request for payment because of a mental or physical condition, the request may be executed on the beneficiary’s behalf by a legal guardian, representative payee, relative, friend, an employee of the institution providing care, or an employee of a governmental agency providing assistance. In this circumstance, unless the requester is a representative payee for the beneficiary, the claim must show the signature and address of the requester with an attached statement explaining the relationship between the requester and the beneficiary, and why the beneficiary can’t sign. This information must be on the claim unless it is on file with the provider.

Example:

NM1*QD*1*JONES*LISA~