NM1

Referring Provider Name

Pos: 250	Max: 1
Detail - Optional
Loop: 2310A	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
The entity identifier in NM101 applies to all segments in this Loop ID-2310.

M

ID

2/3

Required

Code

Name

DN

Referring Provider

Use on first iteration of this loop. Use if loop is used only once.

P3

Primary Care Provider

Use only if loop is used twice. Use only on second iteration of this loop.

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: Referring Provider Last Name
NSF Reference: EA0-24.0

O

AN

1/35

Required

NM104

1036

Name First
Description: Individual first name
Industry: Referring Provider First Name
NSF Reference: EA0-25.0
Required if NM102=1 (person).

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Referring Provider Middle Name
NSF Reference: EA0-26.0
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: Referring Provider Name Suffix
Alias: Referring Provider Generation
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)
Required if Employer’s Identification/Social Security number (Tax ID) or National Provider Identifier is known.

C

ID

1/2

Situational

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: Referring Provider Identifier
Alias: Referring Provider Primary Identifier
NSF Reference: EA0-20.0
Required if Employer’s Identification/Social Security number (Tax ID) or National Provider Identifier is known.

C

AN

2/80

Situational

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. Information in Loop ID-2310 applies to the entire claim unless overridden on a service line by the presence of Loop ID-2420 with the same value in NM101.
2. When there is only one referral on the claim, use code “DN - Referring Provider”. When more than one referral exists and there is a requirement to report the additional referral, use code DN in the first iteration of this loop to indicate the referral received by the rendering provider on this claim. Use code “P3 - Primary Care Provider” in the second iteration of the loop to indicate the initial referral from the primary care provider or whatever provider wrote the initial referral for this patient’s episode of care being billed/reported in this transaction.
3. 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.
4. Required if claim involved a referral.
5. When reporting the provider who ordered services such as diagnostic and lab utilize the 2310A loop at the claim level. For ordered services such as DMERC utilize the 2420E Loop at the line level.

Example:

NM1*DN*1*WELBY*MARCUS*W**JR*34*444332222~