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Back  RFI # 1173: Followup to HIR 1076

Formal vs. Informal Help Informal Formal

Submitter

Jan Klimper

Description

The TR3 states to send a MA15 remark code for split claims in the MIA or MOA segments.

MIA=Medicare Inpatient Adjudication
MOA=Medicare Outpatient Adjudication

Is the split claim remark code only returned for Medicare split claims?

Submitter Assigned Keywords

MIA MOA Remark Code MA15

Response

This issue is explicitly addressed in guide 005010X221. The rules for the MIA and MOA segments read like "Required for all inpatient claims when there is a need to report Remittance Advice Remark Codes at the claim level or, the claim is paid by Medicare...". 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...".

As a result, the requirement to report MA15 is not specific to Medicare, and applies to ALL payers.
Submission 10/6/2010
Status Date 10/21/2010
Status F - Final
Primary References
Document 005010X221
SectionMIA MOA
Page159
Set ID2100