NM105 is situational and should contain <Prior Incorrect Middle Initial or Middle Name> NM106 is situational (follow guide above no WDG requirement) – NM107 is situational (follow guide above no WDG requirement) – NM108 is only required if supplying the SSN in NM109 and should then Note: please DO member’s contain”34” NOT use in NM108 as the value in NM109 will then conflict with the WDG system generated ID# for each “ZZ” member NM109 is situational and should contain <Prior Incorrect SSN >Note: please DO NOT send invalid or duplicate SSN’s for members. Members will not load into the system with duplicate or invalid SSN’s NM110 is NOT USED NM111 is NOT USED NM112 is NOT USED DMG INCORRECT MEMBER DEMOGRAPHICS – X12 Segment Name: Demographic Information X12 Purpose: To supply demographic information Loop: 2100B INCORRECT MEMBER NAME – Usage: Situational TR3 Example: DMG*D8*19450915*M~ Element Detail: Ref Name Type Min/Max Usage DMG01 Date Time Period Format Qualifier ID 2/3 Situational Code indicating the date format, time format, or date & time format Code Definition D8 Date Expressed in Format CCYYMMDD DMG02 Date Time Period AN 1/36 Situational Prior Incorrect Insured Birth Date DMG03 Gender Code ID 1/1 Situational Prior Incorrect Insured Gender Code Code Definition F Female M Male U Unknown DMG04 Marital Status Code ID 1/1 Situational Prior Incorrect Insured Marital Status Code DMG05 Composite Race or Ethnicity Info Situational Prior Incorrect Race or Ethnicity Info Race or Ethnicity information is reported in either DMG05-1 or DMG05-2 and DMG05-3 DMG05-1 Race or Ethnicity Code ID 1/1 Situational Code indicating the racial or ethnic background of a person Ref Name Type Min/Max Usage DMG05-2 Code List Qualifier Code ID 1/3 Situational Code identifying a specific industry code list Code Definition RET Classification of Race or Ethnicity DMG05-3 Industry Code AN 1/30 Situational
NM105 is situational and should contain <Prior Incorrect Middle Initial or Middle Name> NM106 is situational (follow guide above – no WDG requirement) NM107 is situational (follow guide above – no WDG requirement) NM108 is only required if supplying the member’s SSN in NM109 and should then contain”34” Note: please DO NOT use “ZZ” in NM108 as the value in NM109 will then conflict with the WDG system generated ID# for each member NM109 is situational and should contain <Prior Incorrect SSN >Note: please DO NOT send invalid or duplicate SSN’s for members. Members will not load into the system with duplicate or invalid SSN’s NM110 is NOT USED NM111 is NOT USED NM112 is NOT USED DMG – INCORRECT MEMBER DEMOGRAPHICS X12 Segment Name: Demographic Information X12 Purpose: To supply demographic information Loop: 2100B – INCORRECT MEMBER NAME Usage: Situational TR3 Example: DMG*D8*19450915*M~ Element Detail: Ref Name Type Min/Max Usage DMG01 Date Time Period Format Qualifier ID 2/3 Situational Code indicating the date format, time format, or date & time format Code Definition D8 Date Expressed in Format CCYYMMDD DMG02 Date Time Period AN 1/36 Situational Prior Incorrect Insured Birth Date DMG03 Gender Code ID 1/1 Situational Prior Incorrect Insured Gender Code Code Definition F Female M Male U Unknown DMG04 Marital Status Code ID 1/1 Situational Prior Incorrect Insured Marital Status Code DMG05 Composite Race or Ethnicity Info Situational Prior Incorrect Race or Ethnicity Info Race or Ethnicity information is reported in either DMG05-1 or DMG05-2 and DMG05-3 DMG05-1 Race or Ethnicity Code ID 1/1 Situational Code indicating the racial or ethnic background of a person Ref Name Type Min/Max Usage DMG05-2 Code List Qualifier Code ID 1/3 Situational Code identifying a specific industry code list Code Definition RET Classification of Race or Ethnicity DMG05-3 Industry Code AN 1/30 Situational
Williamette_Dental_Group-834-Companion-Guide-5010.docx