VERSION 004010X098A1 - Magellan Provider's Home Page
VERSION 004010X098A1 - Magellan Provider's Home Page
VERSION 004010X098A1 - Magellan Provider's Home Page
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<strong>Magellan</strong> Behavioral Health 837 Professional Companion GuideNM1Element Summary:Subscriber NamePos: 015 Max: 1Detail - OptionalLoop:Elements: 42010BARef Id Element Name Req Type Min/Max UsageNM103 1035 Name Last or Organization NameO AN 1/35 RequiredDescription: Individual last name or organizationalname<strong>Magellan</strong> Specific Note: Full legal name isnecessary to correctly identify the subscriber.Use name as printed on Member Identificationcard.NM104 1036 Name FirstO AN 1/25 SituationalDescription: Individual first name<strong>Magellan</strong> Specific Note: Full legal name isnecessary to correctly identify the subscriber.Use name as printed on Member Identificationcard.NM108 66 Identification Code QualifierC ID 1/2 RequiredDescription: Code designating the system/methodof code structure used for Identification Code (67)<strong>Magellan</strong> Specific Note: Only value 'MI' is usedby <strong>Magellan</strong>.NM109 67 Identification CodeC AN 2/80 RequiredDescription: Code identifying a party or other code<strong>Magellan</strong> Specific Note: Submit the numberprinted on the Member Identification Card._________________________________________________________________________________________________________________________Revised: February 14, 2008 HIPAA X12 837p (<strong>004010X098A1</strong>) Version 7 14
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