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Segment
in
X12 Release 003030

MIA Medicare Inpatient Adjudication

To provide claim level data related to the adjudication of Medicare patient claims
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
380
Quantity
Decimal number (R)
Mandatory
1
15
-
Numeric value of quantity.
MIA01 is covered days.
02
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
MIA02 is lifetime reserve days.
03
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
MIA03 is lifetime psychiatric days.
04
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA04 is Diagnosis Related Group (DRG) amount.
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.
06
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA06 is the disproportionate share amount.
07
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA07 is the Medicare Secondary Payer (MSP) pass-through amount.
08
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA08 is the total Prospective Payment System (PPS) capital amount.
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.
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.
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.
12
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA12 is the old capital amount.
13
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA13 is the Prospective Payment System (PPS) capital indirect medical education claim amount.
14
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA14 is hospital specifc Diagnosis Related Group (DRG) Amount.
15
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
MIA15 is the cost report days.
16
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA16 is the federal specific Diagnosis Related Group (DRG) amount.
17
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA17 is the Prospective Payment System (PPS) Capital Outlier amount.
18
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA18 is the indirect teaching amount.
19
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA19 is the professional component amount billed but not payable.
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.
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.
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.
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.
24
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MIA24 is the capital exception amount.
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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.