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Back  RFI # 560: Claim Level Remarks

Formal vs. Informal Help Informal Formal

Submitter

Jennifer McMullin

Description

We need further clarification on this issue. Since this is a professional claim and not an institutional clam (inpatient vs outpatient), which segment would we output the claim level remarks in? The MIA or the MOA? Professional claims are not categorized by inpatient or outpatient, so which do we populate for claim level remarks?

Issue 559: Our adjudication system allows payers to apply adjustment codes and remark codes at a claim level on professional claims. In this scenario, where would we output these remark codes on the 835? These are not line level remark codes, so we're assuming that they shouldn't go in the LX segments. Would we populate them in the MIA or MOA segments?

Submitter Assigned Keywords

MOA MIA

Response

The claim level remark codes should be reported in the MOA Segment for professional claims.

Recommendation

Even though professional claims are not globally termed as outpatient, they should follow the required and situational rules of such.
The 005010X221 TR3 has notes to include professional claims anywhere outpatient claims are listed.
Submission 5/16/2007
Status Date 8/6/2007
Status F - Final
Primary References
Document 004010X091
Section2100
Page118
Set ID835