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Sunday, February 26, 2017

EDI 270–5010 Documentation–2100A Information Source Name

2100A Information Source Name

The information source is the entity who has the answer to the questions being asked in a 270 Eligibility or Benefit transaction. The information source is typically the insurer, or payer.

Use this segment to identify an entity by name and/or identification number. This NM1 loop is used to identify the eligibility or benefit information source (e.g., insurance company, HMO, IPA, employer).

Now let’s start the detail implementation.

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
Header	NM1	Payer Name	ID	3		R	NM1
		Element Separator	AN	1			*
	NM101	Entity Identifier Code	ID	2/3	98	R	PR
		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	Insurance 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	PI
		Element Separator	AN	1			*
	NM109	Identification code	AN	2/80	67	R	Payer ID
		Segment Terminator					~

NM102 - Entity Type Qualifier

Code qualifying the type of entity

Code	Definition
1	Person
2	Non-Person Entity

Sample
NM1*PR*2*FLORIDA BLUE*****PI*BCBSF~

Segment Structure

Questions or feedback are always welcome. You can email me at Available link for download

EDI 270–5010 Documentation– Loop 2100C SUBSCRIBER Name

2100C Subscriber Name

Use this segment to identify an entity by name and/or identification number. Use this NM1 loop to identify the insured or subscriber

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2100C	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

Sample
NM1*IL*1*MULLIN*DANIEL****MI*XJBH12345678~

Segment Structure

SUBSCRIBER DEMOGRAPHIC INFORMATION

Use this segment to convey the birth date or gender demographic information for the subscriber. Use this segment only if the subscriber is the patient and if this information is available from the Information Source’s database.

Available link for download

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

Roviyas

Sunday, February 26, 2017

EDI 270–5010 Documentation–2100A Information Source Name

EDI 270–5010 Documentation–2100A Information Source Name

Saturday, February 25, 2017

EDI 270–5010 Documentation– Loop 2100C SUBSCRIBER Name

EDI 270–5010 Documentation– Loop 2100C SUBSCRIBER Name

Saturday, January 28, 2017

EDI 270–5010 Documentation–2000B Information Receiver Name

EDI 270–5010 Documentation–2000B Information Receiver Name