Loops and Segments Table – Loop 2330A Other Subscriber Name and Address

Usage : Required
Element : NM101
Value : IL
Comment : Code identifying the insured or subscriber

Usage : Required
Element : NM102
Value :
1 = Person
2 = Nonperson Entity

Comment : Code qualifying the type of entity.

Usage : Required
Element : NM103
Value : NIL
Comment : Last Name or Organization Name

Usage : Situational
Element : NM104
Value : NIL
Comment : Subscriber first name

Usage : Situational
Element : NM105
Value : NIL
Comment : Subscriber middle.

Usage : Situational
Element : NM107
Value : NIL
Comment : Subscriber generation (suffix)

Usage : Required
Element : NM108
Value : MI = Member Identification Number to convey the following terms: Insured’s ID, Subscriber’s ID, Health Insurance Claim Number (HIC), etc.
Comment : Code to indicate Member ID

Usage : Required
Element : NM109
Value : Nil
Comment : Identification Number.

Usage : Required
Element : N301
Value : Nil
Comment : Address Information (address 1)

Usage : Situational
Element : N302
Value : Nil
Comment : Address Information (address 2) required if second address exists.

Usage : Situational
Element : N401
Value : Nil
Comment : City Name Required when information is available.

Usage : Situational
Element : N402
Value : Nil
Comment : State or Province Code Required when information is available.

Usage : Situational
Element : N403
Value : Nil
Comment : Postal Code Required when information is available.

Usage : Situational
Element : N404
Value : Nil
Comment : Country Code Required if the address is out of the U.S.