NM1

Service Facility Location

Pos: 250	Max: 1
Detail - Optional
Loop: 2310D	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

77

Service Location

Use when other codes in this element do not apply.

FA

Facility

LI

Independent Lab

TL

Testing Laboratory

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: Laboratory or Facility Name
Alias: Laboratory/Facility Name
NSF Reference: EA0-39.0
Required except when service was rendered in the patient’s home.

O

AN

1/35

Situational

NM108

66

Identification Code Qualifier
Description: Code designating the system/method of code structure used for Identification Code (67)
Required if either Employer’s Identification/Social Security Number 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: Laboratory or Facility Primary Identifier
Alias: Laboratory/Facility Primary Identifier
NSF Reference: EA1-04.0, EA0-53.0
Required if either Employer’s Identification/Social Security Number 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. 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. This loop is required when the location of health care service is different than that carried in the 2010AA (Billing Provider) or 2010AB (Pay-to Provider) loops.
4. Required if the service was rendered in a Health Professional Shortage Area (QB or QU modifier billed) and the place of service is different than the HPSA billing address.
5. The purpose of this loop is to identify specifically where the service was rendered. In cases where it was rendered at the patient’s home, do not use this loop. In that case, the place of service code in CLM05- 1 should indicate that the service occurred in the patient’s home.

Example:

NM1*TL*2*A-OK MOBILE CLINIC*****24*11122333~