MOA Outpatient Adjudication

To provide claim level data related to the adjudication of outpatient claims

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

Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through 100%)

MOA01 is the reimbursement rate.

Position: MOA-02 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 18 · Repeat: 1

Monetary amount

MOA02 is the claim Healthcare Common Procedure Coding System (HCPCS) payable amount.

Position: MOA-03 · Element: 127 · Name: Reference Identification · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 80 · Repeat: 1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

MOA03 is the Remittance Advice Remark Code. See Code Source 411.

Position: MOA-04 · Element: 127 · Name: Reference Identification · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 80 · Repeat: 1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

MOA04 is the Remittance Advice Remark Code. See Code Source 411.

Position: MOA-05 · Element: 127 · Name: Reference Identification · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 80 · Repeat: 1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

MOA05 is the Remittance Advice Remark Code. See Code Source 411.

Position: MOA-06 · Element: 127 · Name: Reference Identification · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 80 · Repeat: 1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

MOA06 is the Remittance Advice Remark Code. See Code Source 411.

Position: MOA-07 · Element: 127 · Name: Reference Identification · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 80 · Repeat: 1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

MOA07 is the Remittance Advice Remark Code. See Code Source 411.

Position: MOA-08 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 18 · Repeat: 1

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: 18 · Repeat: 1

Monetary amount

MOA09 is the professional component amount billed but not payable.