MOA Medicare Outpatient Adjudication

To convey claim level data related to the adjudication of Medicare Outpatient claims

Position: MOA-01 · Element: 954 · Name: Percent · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 10 · Repeat: -

Percentage expressed as a decimal

MOA01 is the reimbursement rate.

Position: MOA-02 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

MOA02 is the claim Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount.

Position: MOA-03 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

MOA03 is the local Medicare intermediary or insurance carrier reason code.

Position: MOA-04 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

MOA04 is the local Medicare intermediary or insurance carrier reason code.

Position: MOA-05 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

MOA05 is the local Medicare intermediary or insurance carrier reason code.

Position: MOA-06 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

MOA06 is the local Medicare intermediary or insurance carrier reason code.

Position: MOA-07 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

MOA07 is the local Medicare intermediary or insurance carrier reason code.

Position: MOA-08 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

MOA08 is the End Stage Renal Disease (ESRD) payment amount.

Position: MOA-09 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

MOA09 is the professional component amount billed but not payable.