EDI 5010 Documentation 837 Professional - Loop 2010BA Subscriber Name

2010BA Subscriber Name

 

        

 

 

In this loop, all the information will be taken from Patient Insurance(policy) information screen. Take a look of our sample screen here how patient insurance information are stored in the system.

Now let’s start the detail implementation.

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2010BA	NM1	Subscriber Name	ID	3		R	NM1
		Element Separator	AN	1			*
	NM101	Entity Identifier Code	ID	2/3	98	R	IL
		Element Separator	AN	1			*
	NM102	Entity Type qualifier	ID	1/1	1065	R	1
		Element Separator	AN	1			*
	NM103	Name Last or Organization Name	AN	1/60	1035	R	Insured Person Last Name
		Element Separator	AN	1			*
	NM104	Name First	AN	1/35	1036	S	Insured Person First Name
		Element Separator	AN	1			*
	NM105	Name Middle	AN	1/25	1037	S	Insured Person Middle Name
		Element Separator	AN	1			*
	NM106	Name Prefix	AN	1/10	1038	Not used
		Element Separator	AN	1			*
	NM107	Name Suffix	AN	1/10	1039	S	Insured Person Suffix
		Element Separator	AN	1			*
	NM108	Identification code Qualifier	ID	1/2	66	R	MI
		Element Separator	AN	1			*
	NM109	Identification code	AN	2/80	67	R	Insured Policy No
		Segment Terminator					~

 

 

NM102 - Entity Type Qualifier

Code qualifying the type of entity

Code	Definition
1	Person
2	Non-Person Entity

2010BA Subscriber Address

 

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2010BA	N3	Subscriber Address	AN	2		R	N3
		Element Separator	AN	1			*
	N301	Address Line 1	AN	1/55	166	R	Insured Person Address Line 1
		Element Separator	AN	1			*
	N302	Address Line 2	AN	1/55	1065	S	Insured Person Address Line 2 if exists
		Segment Terminator					~

 

2010BA Subscriber City/State/Zip code

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2010BA	N4	Subscriber City / State / Zip Code	AN	2		R	N4
		Element Separator	AN	1			*
	N401	City Name	AN	2/30	19	R	Insured Person City Name
		Element Separator	AN	1			*
	N402	State or Province Code	ID	2/2	156	R	Insured Person State Code
		Element Separator	AN	1			*
	N403	Postal Code	ID	3/15	116	R	Insured Person Zip Code
		Segment Terminator					~

2010BA Subscriber Demographic Information.

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2010BA	DMG	Subscriber Demographic	ID	3		R	DMG
		Element Separator	AN	1			*
	DMG01	Date time Period Format Qualifier	ID	2/3	1250	R	D8
		Element Separator	AN	1			*
	DMG02	Date time Period	AN	1/35	1251	R	Insured Date of birth in the Format CCYYMMDD
		Element Separator	AN	1			*
	DMG03	Gender Code	ID	1	1068	R	Print M for Male Print F for Female Print U for unknown
		Segment Terminator					~

2010BA Subscriber Name – Sample

Patient Insurance Policy Information

Field	Value
Insured Last Name	Balwant
Insured First Name	Singal
Insured Policy Number	3A3G3343
Insured Address line 1	7508 Et, Road
Insured Address Line 2	Nullam Av
Insured City	Frisco City
Insured State	NY
Insured Zip Code	112348888
Insured DOB (mm/dd/yyyy)	12/11/1938
Insured Gender	Female

 

NM1*IL*1*BALWANT*SINGAL****MI*3A3G3343~
N3*7508 Et, Road*Nullam Av~
N4*Frisco City*NY*112348888~
DMG*D8*19381211*F~

 

 

        

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