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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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PR |
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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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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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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AD |
Blue Cross Blue Shield Association Plan Code |
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Description: Unique 3-digit number assigned to independent Blue Cross or Blue Shield plans by Blue Cross/Blue Shield Association |
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FI |
Federal Taxpayer's 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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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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NM109 |
67 |
Identification Code |
C |
AN |
2/80 |
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Description: Code identifying a party or other code |
