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Back  RFI # 1754: Usage of Loop 2330B NM103

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Texas Medicaid is requiring the Other Insurance policy effective date and termination date in the loop 2330B Other Payer Last Name or Organization Name field - NM103.

Their companion guide states NM103 should be submitted with the following information:
Positions 1-40 - OtherPayer Name or Organization Name
Positions 41-48 - Policy Effective Date in YYYYMMDD format
Positions 49-56 - Policy Termination Date in YYYYMMDD format.

Is this compliant with the intended usage of this field? They have indicated that it has been approved to use in this manner since there are no other DTP segments to capture policy dates about the other insurance.

Submitter Assigned Keywords

837I Texas Loop 2330B


No. It is not compliant with the TR3 to include a date within the 2330B NM103 Payer last name field.
Submission 2/19/2013
Status Date 4/5/2013
Status F - Final
Primary References
Document 005010X223
Segment Position1
Segment IDNM1
Element Position3