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Back  RFI # 1777: ERA - Use of MIA and MOA

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Submitter

Reggie Mano

Description

At present, we are providing the new HIPAA code combinations (CAGC, CARC, and RARC) in the CAS and LQ segments of the ERA file. We are reporting the associated adjustment amounts in the CAS segments. We report both commercial and Medicare claims this way and do not use the MIA and MOA segments. What is the appropriate way to report the code combinations and associated adjustment amounts for Medicare claims? Are the MIA and MOA segments used instead of the CAS for Medicare claims?

Submitter Assigned Keywords

ERA MIA MOA Medicare

Response

The Health Care Claim Payment/Advice Technical Report Type 3 (005010X221A1) provides the following guidance on the use of CAS, LQ, MIA, and MOA segments.

As explained in §1.10.2.4, claims and service adjustments are reported using CAS segments at the claim (loop 2100) or service (loop 2110) level as appropriate. The CAS segments report the Claim Adjustment Group Code (CAGC) and Claim Adjustment Reason Code (CARC) that explain the adjustment. These requirements apply to all claims, including Commercial and Medicare.

If a service Remittance Advice Remark Code (RARC) is appropriate, it is reported in an LQ segment. If a claim RARC is appropriate, it is reported in an MIA or MOA segment for inpatient and outpatient claims respectively. These requirements apply to all claims, including Commercial and Medicare.

Although the version 5010 MIA and MOA X12 segment names contain the word ‘Medicare’, they are not used only by Medicare. In fact, ‘Medicare’ will be dropped from these segment names in the next version of the TR3.

Therefore, the MIA and MOA segments are never used to report adjustment amounts. Medicare and commercial adjustments are only reported in CAS segments.

Recommendation

The MIA and MOA segments contain several amount elements that are not adjustments, but may be required for Medicare or Medicaid claims. Specific requirements are detailed in the MIA and MOA situational rules and TR3 notes
Submission 4/11/2013
Status Date 5/24/2013
Status F - Final
Primary References
Document 005010X221
Section3.2
Page11
Table2
Loop2100
Segment IDMIA
Secondary References
RFI ID 2250
Document 005010X221
Section3.2
Page11
Table2
Loop2110
Segment IDMOA