RFI Browser

Back  RFI # 1055: MOA02 HCPC Payable Amount

Formal vs. Informal Help Informal Formal

Submitter

Dora Lambert

Description

In the 5010 TR3, MOA segment there is a situational rule that says the segment is required for outpatient/professional claims where there is a need to report a RARC at the claim level or when the payer is Medicare or Medicaid and MOA01, 02, 08 or 09 are non-zero. The MOA02 data element situational rule says this data element is required when the outpatient institutional claim HCPCS Payable Amount is not zero for a Medicare or Medicaid claim.

What is the Medicaid requirement? What is the HCPC payable amount? Is it the sum of all lines?

Submitter Assigned Keywords

MOA02 HCPCS Payable Amount

Response

The requirement for Medicaid specific to MOA02 is that the segment and element are required whenever the HCPCS Payable Amount is non-zero. So, if the payer is Medicaid and any of the services within the claim identifies a HCPCS code as the adjudicated procedure code (SVC01-2) without rejecting that service line then the MOA segment and MOA02 must be present.

MOA02 is the sum of all paid HCPCS service lines on the claim when not zero.

A HCPCS service line is defined as a service line that is paid based upon a HCPCS procedure code. If not paid by HCPCS procedure codes then this would not be populated.
Submission 5/21/2010
Status Date 9/15/2010
Status F - Final
Primary References
Document 005010X221
Section2.4
Page166
Set ID835
Table2
Loop2100
Segment Position0350
Segment IDMOA
Element Position02
Industry NameOutpatient Adjudication Information