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_Ref_ |
Id |
_________Element Name__________ |
Req |
Type |
Min/Max |
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NM101 |
98 |
Entity Identifier Code |
M |
ID |
2/3 |
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Description: Code identifying an organizational entity, a physical location, property or an individual |
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Code |
Name_______________________________ |
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13 |
Contracted Service Provider |
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1P |
Provider |
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2B |
Third-Party Administrator |
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36 |
Employer |
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73 |
Other Physician |
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Description: Physician not one of the other specified choices |
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FA |
Facility |
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GP |
Gateway Provider |
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Description: Identifies a gateway access provider |
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IL |
Insured or Subscriber |
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LR |
Legal Representative |
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P3 |
Primary Care Provider |
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Description: Physician that is selected by the insured to provide medical care |
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P4 |
Prior Insurance Carrier |
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P5 |
Plan Sponsor |
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PR |
Payer |
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VN |
Vendor |
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X3 |
Utilization Management Organization |
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PRP |
Primary Payer |
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SEP |
Secondary Payer |
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TTP |
Tertiary Payer |
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NM102 |
1065 |
Entity Type Qualifier |
M |
ID |
1/1 |
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Description: Code qualifying the type of entity |
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Code |
Name_______________________________ |
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1 |
Person |
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2 |
Non-Person Entity |
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NM103 |
1035 |
Name Last or Organization Name |
O |
AN |
1/35 |
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Description: Individual last name or organizational name |
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NM104 |
1036 |
Name First |
O |
AN |
1/25 |
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Description: Individual first name |
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NM105 |
1037 |
Name Middle |
O |
AN |
1/25 |
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Description: Individual middle name or initial |
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NM107 |
1039 |
Name Suffix |
O |
AN |
1/10 |
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Description: Suffix to individual name |
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NM108 |
66 |
Identification Code Qualifier |
C |
ID |
1/2 |
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Description: Code designating the system/method of code structure used for Identification Code (67) |
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Code |
Name_______________________________ |
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24 |
Employer's Identification Number |
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34 |
Social Security Number |
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46 |
Electronic Transmitter Identification Number (ETIN) |
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Description: A unique number assigned to each transmitter and software developer |
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FA |
Facility Identification |
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FI |
Federal Taxpayer's Identification Number |
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MI |
Member Identification Number |
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NI |
National Association of Insurance Commissioners (NAIC) Identification |
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PI |
Payor Identification |
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PP |
Pharmacy Processor Number |
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Description: Unique number assigned to each pharmacy for submitting claims |
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SV |
Service Provider Number |
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XV |
Health Care Financing Administration National Payer Identification Number (PAYERID) |
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Description: Required if the National PlanID is mandated for use. Otherwise, one of the other listed codes may be used. |
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XX |
Health Care Financing Administration National Provider Identifier |
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Description: Required value if the National Provider ID is mandated for use. Otherwise, one of the other listed codes may be used. |
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ZZ |
Mutually Defined |
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NM109 |
67 |
Identification Code |
C |
AN |
2/80 |
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Description: Code identifying a party or other code |
