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Segment
in
X12 Release 003030

MOA Medicare Outpatient Adjudication

To convey claim level data related to the adjudication of Medicare Outpatient claims
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
954
Percent
Decimal number (R)
Optional
1
10
-
Percentage expressed as a decimal
MOA01 is the reimbursement rate.
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.
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.
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.
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.
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.
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.
08
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
MOA08 is the End Stage Renal Disease (ESRD) payment amount.
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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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.