MIA

Inpatient Adjudication Information

Pos: 033

Max: 1

Detail - Optional

Loop: 2100

Elements: 24


User Option (Usage): Situational
To provide claim-level data related to the adjudication of Medicare inpatient claims

Element Summary:

 

Ref

Id

Element Name

Req

Type

Min/Max

Usage

 

MIA01

380

Quantity
Description: Numeric value of quantity
Industry: Covered Days or Visits Count
Implementers of this guideline always transmit the number zero. See the QTY segment at the claim level for covered days or visits count.

M

R

1/15

Required

 

MIA02

380

Quantity
Description: Numeric value of quantity
Industry: PPS Operating Outlier Amount
Use this to report PPS Operating Outlier.
Additional payment for excessive cost incurred by provider.

O

R

1/15

Situational

 

MIA03

380

Quantity
Description: Numeric value of quantity
Industry: Lifetime Psychiatric Days Count
Use this number for the lifetime psychiatric days.

O

R

1/15

Situational

 

MIA04

782

Monetary Amount
Description: Monetary amount
Industry: Claim DRG Amount
Use this monetary amount for the DRG amount.

O

R

1/18

Situational

 

MIA05

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Remark Code
Used when a Remittance Remark Code applies to this claim.

O

AN

1/30

Situational

 

ExternalCodeList

 

Name: 411

 

Description: Remittance Remark Codes

 

MIA06

782

Monetary Amount
Description: Monetary amount
Industry: Claim Disproportionate Share Amount
Use this monetary amount for the disproportionate share amount.

O

R

1/18

Situational

 

MIA07

782

Monetary Amount
Description: Monetary amount
Industry: Claim MSP Pass-through Amount
Use this monetary amount for the MSP pass through amount.

O

R

1/18

Situational

 

MIA08

782

Monetary Amount
Description: Monetary amount
Industry: Claim PPS Capital Amount
Use this monetary amount for the total PPS capital amount.

O

R

1/18

Situational

 

MIA09

782

Monetary Amount
Description: Monetary amount
Industry: PPS-Capital FSP DRG Amount
Use this monetary amount for the PPS capital, federal-specific portion DRG amount.

O

R

1/18

Situational

 

MIA10

782

Monetary Amount
Description: Monetary amount
Industry: PPS-Capital HSP DRG Amount
Use this monetary amount for the PPS capital, hospital-specific portion DRG amount.

O

R

1/18

Situational

 

MIA11

782

Monetary Amount
Description: Monetary amount
Industry: PPS-Capital DSH DRG Amount
Use this monetary amount for the PPS capital, disproportionate share, hospital DRG amount.

O

R

1/18

Situational

 

MIA12

782

Monetary Amount
Description: Monetary amount
Industry: Old Capital Amount
Use this monetary amount for the old capital amount.

O

R

1/18

Situational

 

MIA13

782

Monetary Amount
Description: Monetary amount
Industry: PPS-Capital IME amount
Use this monetary amount for the PPS capital indirect medical education claim amount.

O

R

1/18

Situational

 

MIA14

782

Monetary Amount
Description: Monetary amount
Industry: PPS-Operating Hospital Specific DRG Amount
Use this monetary amount for the PPS (operating)/hospital-specific DRG amount.

O

R

1/18

Situational

 

MIA15

380

Quantity
Description: Numeric value of quantity
Industry: Cost Report Day Count
Use this number for the cost report days.

O

R

1/15

Situational

 

MIA16

782

Monetary Amount
Description: Monetary amount
Industry: PPS-Operating Federal Specific DRG Amount
Use this monetary amount for the PPS (operating)/federal-specific DRG amount.

O

R

1/18

Situational

 

MIA17

782

Monetary Amount
Description: Monetary amount
Industry: Claim PPS Capital Outlier Amount
Use this monetary amount for the PPS capital outlier amount. This amount excludes the operating outlier amount, which is reflected in the AMT segment.

O

R

1/18

Situational

 

MIA18

782

Monetary Amount
Description: Monetary amount
Industry: Claim Indirect Teaching Amount
Use this monetary amount for the indirect teaching amount.

O

R

1/18

Situational

 

MIA19

782

Monetary Amount
Description: Monetary amount
Industry: Nonpayable Professional Component Amount
Use this monetary amount for the professional component amount billed but not payable.

O

R

1/18

Situational

 

MIA20

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Remark Code
Used when additional remittance remarks apply to this claim.

O

AN

1/30

Situational

 

ExternalCodeList

 

Name: 411

 

Description: Remittance Remark Codes

 

MIA21

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Remark Code
Used when additional remittance remarks apply to this claim.

O

AN

1/30

Situational

 

ExternalCodeList

 

Name: 411

 

Description: Remittance Remark Codes

 

MIA22

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Remark Code
Used when additional remittance remarks apply to this claim.

O

AN

1/30

Situational

 

ExternalCodeList

 

Name: 411

 

Description: Remittance Remark Codes

 

MIA23

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Remark Code
Used when additional remittance remarks apply to this claim.

O

AN

1/30

Situational

 

ExternalCodeList

 

Name: 411

 

Description: Remittance Remark Codes

 

MIA24

782

Monetary Amount
Description: Monetary amount
Industry: PPS-Capital Exception Amount
Use this monetary amount for the capital exception amount.

O

R

1/18

Situational


Semantics:

1.

MIA01 is the covered days.

2.

MIA02 is the lifetime reserve days.

3.

MIA03 is the lifetime psychiatric days.

4.

MIA04 is the Diagnosis Related Group (DRG) amount.

5.

MIA05 is the Claim Payment Remark Code. See Code Source 411.

6.

MIA06 is the disproportionate share amount.

7.

MIA07 is the Medicare Secondary Payer (MSP) pass-through amount.

8.

MIA08 is the total Prospective Payment System (PPS) capital amount.

9.

MIA09 is the Prospective Payment System (PPS) capital, federal specific portion, Diagnosis Related Group (DRG) amount.

10.

MIA10 is the Prospective Payment System (PPS) capital, hospital specific portion, Diagnosis Related Group (DRG), amount.

11.

MIA11 is the Prospective Payment System (PPS) capital, disproportionate share, hospital Diagnosis Related Group (DRG) amount.

12.

MIA12 is the old capital amount.

13.

MIA13 is the Prospective Payment System (PPS) capital indirect medical education claim amount.

14.

MIA14 is hospital specific Diagnosis Related Group (DRG) Amount.

15.

MIA15 is the cost report days.

16.

MIA16 is the federal specific Diagnosis Related Group (DRG) amount.

17.

MIA17 is the Prospective Payment System (PPS) Capital Outlier amount.

18.

MIA18 is the indirect teaching amount.

19.

MIA19 is the professional component amount billed but not payable.

20.

MIA20 is the Claim Payment Remark Code. See Code Source 411.

21.

MIA21 is the Claim Payment Remark Code. See Code Source 411.

22.

MIA22 is the Claim Payment Remark Code. See Code Source 411.

23.

MIA23 is the Claim Payment Remark Code. See Code Source 411.

24.

MIA24 is the capital exception amount.


Notes:

1. This segment should be generated by Medicare intermediaries.
2. Either MIA or MOA will appear, but not both.
3. This segment should not be used for covered days or lifetime reserve days. Use the Supplemental Claim Information Quantities Segment in the Claim Payment Loop.
4. All situational quantities and amounts in this segment are required when the value of the item is different than zero.
5. Payers and Payees outside of Medicare community may need to use this segment.

Example:

MIA*0***138018.4~


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