EDI 270–5010 Documentation–2000B Information Receiver Name

2000B Information Receiver Name

Use this segment to identify an entity by name and/or identification number. This NM1 loop is used to identify the eligibility/benefit
information receiver (e.g., provider, medical group, employer, IPA, or hospital).

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
Header	NM1	Submitter Name	ID	3		R	NM1
		Element Separator	AN	1			*
	NM101	Entity Identifier Code	ID	2/3	98	R	See Below for valid values
		Element Separator	AN	1			*
	NM102	Entity Type qualifier	ID	1/1	1065	R	2 (See below for more Information)
		Element Separator	AN	1			*
	NM103	Name Last or Organization Name	AN	1/60	1035	R	Practice Name
		Element Separator	AN	1			*
	NM104	Name First	AN	1/35	1036	Not used
		Element Separator	AN	1			*
	NM105	Name Middle	AN	1/25	1037	Not Used
		Element Separator	AN	1			*
	NM106	Name Prefix	AN	1/10	1038	Not used
		Element Separator	AN	1			*
	NM107	Name Suffix	AN	1/10	1039	Not Used
		Element Separator	AN	1			*
	NM108	Identification code Qualifier	ID	1/2	66	R	XX (See below for more information)
		Element Separator	AN	1			*
	NM109	Identification code	AN	2/80	67	R	NPI Number
		Segment Terminator					~

 

Sample

NM1*1P*2*Bella Vista Health Center*****XX*1306849724~

Segment Structure


NM101 - Entity Identifier Code

Code qualifying the type of entity

Code	Definition
1P	Provider
2B	Third-Party Administrator
36	Employer
80	Hospital
FA	Facility
GP	Gateway Provider
P5	Plan Sponsor
PR	Payer

 

NM102 - Entity Type Qualifier

Code qualifying the type of entity

Code	Definition
1	Person
2	Non-Person Entity

 

NM108 – Identification code Qualifier

Code qualifying the type of entity

Code	Definition
24	Employer Identification Number
34	Social Security Number
FI	Federal TaxPayer Identification Number
PI	Payer Identification Number
PP	Pharmacy Processor Number
SV	Service Provider Number
XV	Health Care Financing Administration National PlanID
XX	Health Care Financing Administration National Provider Identifier

 

        

 

 

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