MOA Medicare Outpatient Adjudication

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

Position
Element
Name
Type
Requirement
Min
Max
Repeat
MOA-01
Percent
Decimal number (R)
Optional
1
10
-
Percentage expressed as a decimal
MOA01 is the reimbursement rate.
MOA-02
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MOA02 is the claim Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount.
MOA-03
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.
MOA03 is the local Medicare intermediary or insurance carrier reason code.
MOA-04
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.
MOA04 is the local Medicare intermediary or insurance carrier reason code.
MOA-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.
MOA05 is the local Medicare intermediary or insurance carrier reason code.
MOA-06
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.
MOA06 is the local Medicare intermediary or insurance carrier reason code.
MOA-07
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.
MOA07 is the local Medicare intermediary or insurance carrier reason code.
MOA-08
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MOA08 is the End Stage Renal Disease (ESRD) payment amount.
MOA-09
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MOA09 is the professional component amount billed but not payable.

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