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Back  RFI # 1076: MIA/MOA & split claims

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Submitter

Jan Klimper

Description

The 5010 front matter states the MIA or MOA must be returned at the claim level with a remark code when a claim is split. However, the MIA/MOA rules and notes do not state to use these for split claims. Please confirm use and rules.

Response

This issue is explicitly addressed in guide 005010X221. The segment notes on the MIA and MOA segments include "Required for all ... claims when there is a need to report Remittance Advice Remark Codes at the claim level...". This establishes a requirement.

The front matter section 1.10.2.11 states "In addition, payers must identify each claim as being part of a split claim by utilizing the MIA or MOA segment with Remittance Advice Remark Code MA15...". This identifies a specific situation where the Remark Codes are needed at the claim level, an instance of that MIA or MOA segment requirement.

The use and rules are confirmed.
Submission 6/14/2010
Status Date 7/2/2010
Status F - Final
Primary References
Document 005010X221
Section1.10.211
Page159
Set IDMIA
Loop2100