MIA Medicare Inpatient Adjudication

To provide claim level data related to the adjudication of Medicare patient claims

Position
Element
Name
Type
Requirement
Min
Max
Repeat
MIA-01
Quantity
Decimal number (R)
Mandatory
1
15
-
Numeric value of quantity.
MIA01 is covered days.
MIA-02
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
MIA02 is lifetime reserve days.
MIA-03
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
MIA03 is lifetime psychiatric days.
MIA-04
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA04 is Diagnosis Related Group (DRG) amount.
MIA-05
Reference Number
String (AN)
Optional
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
MIA05 is the Medicare local intermediary reason code.
MIA-06
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA06 is the disproportionate share amount.
MIA-07
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA07 is the Medicare Secondary Payer (MSP) pass-through amount.
MIA-08
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA08 is the total Prospective Payment System (PPS) capital amount.
MIA-09
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA09 is the Prospective Payment System (PPS) capital, federal specific portion, Diagnosis Related Group (DRG) amount.
MIA-10
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA10 is the Prospective Payment System (PPS) capital, hospital specific portion, Diagnosis Related Group (DRG), amount.
MIA-11
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA11 is the Prospective Payment System (PPS) capital, disaproportionate share, hospital Diagnosis Related Group (DRG) amount.
MIA-12
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA12 is the old capital amount.
MIA-13
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA13 is the Prospective Payment System (PPS) capital indirect medical education claim amount.
MIA-14
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA14 is hospital specifc Diagnosis Related Group (DRG) Amount.
MIA-15
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
MIA15 is the cost report days.
MIA-16
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA16 is the federal specific Diagnosis Related Group (DRG) amount.
MIA-17
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA17 is the Prospective Payment System (PPS) Capital Outlier amount.
MIA-18
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA18 is the indirect teaching amount.
MIA-19
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA19 is the professional component amount billed but not payable.
MIA-20
Reference Number
String (AN)
Optional
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
MIA20 is the Medicare local intermediary reason code.
MIA-21
Reference Number
String (AN)
Optional
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
MIA21 is the Medicare local intermediary reason code.
MIA-22
Reference Number
String (AN)
Optional
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
MIA22is the Medicare local intermediary reason code.
MIA-23
Reference Number
String (AN)
Optional
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
MIA23 is the Medicare local intermediary reason code.
MIA-24
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA24 is the capital exception amount.

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