Wednesday, 14 May 2014

271–5010 Health Care Eligibility Benefit Response – Loop 2100C Subscriber Name

 
        

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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
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SUBSCRIBER Additional identification

Loop Seg ID Segment Name Format Length Ref# Req Value
2100C REF Reference Identification ID 3 R REF
Element Separator AN 1 *
REF01 Reference Identification qualifier ID 2/3 128 R See below for valid values
Element Separator AN 1 *
REF02 Reference Identification AN 1/50 127 R Identification value
    Element Separator AN 1 *
  REF03 Description AN 1/80 352 S Free form description as optional

REF01- Reference Identification Type Qualifier
 
Code Definition
18 Plan Number
1L Group Policy Number
1W Member Identification Number
3H Case Number
49 Family Unit Number
6P Group Number
CE Class of Contract
CT Contract Number
EA Medical Record  Identification Number
EJ Patient Account Number
F6 Health Insurance Claim (HIC) Number
GH Identification Card Serial Number
HJ Identify Card Number
IF Issue Number
IG Insurance Policy Number
N6 Plan Network Identification Number
NQ Medicaid Recipient Identification Number
Q4 Prior Identifier Number
SY Social Security Number
Y4 Agency Claim Number
   

Sample
REF*6P*1111119*XXXXXXX XXXXXXXXXX XXXXXXXXX, INC.
REF*EJ*660415~

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2100C Subscriber Address
 
Loop Seg ID Segment Name Format Length Ref# Req Value
2100C 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 1/55 166 S Insured Person Address Line 2 if exists
Segment Terminator ~

 
2100C Subscriber City/State/Zip code
Loop Seg ID Segment Name Format Length Ref# Req Value
2100C 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 ~



2100C Subscriber Demographic Information.
Loop Seg ID Segment Name Format Length Ref# Req Value
2100C 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

Sample

N3*254 Holly ST
N4*HYDE PARK*NY*011111117
DMG*D8*19521212*M


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Questions or feedback are always welcome. You can email me at vbsenthilinnet@gmail.com.  

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