Roviyas: EDI 270–5010 Documentation–2000B Information Receiver Name

Saturday, January 28, 2017

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

Available link for download