Position

Element

Name

Type

Requirement

Min

Max

Repeat

MIA-01Quantity

Decimal number (R)

Mandatory

1

15

1

Numeric value of quantity

MIA01 is the covered days.

MIA-02Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

MIA02 is the Prospective Payment System (PPS) Operating Outlier amount.

MIA-03Quantity

Decimal number (R)

Optional

1

15

1

Numeric value of quantity

MIA03 is the lifetime psychiatric days.

MIA-04Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

MIA04 is the Diagnosis Related Group (DRG) amount.

MIA-05Reference Identification

String (AN)

Optional

1

50

1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

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

MIA-06Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

MIA06 is the disproportionate share amount.

MIA-07Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

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

MIA-08Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

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

MIA-09Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

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

MIA-10Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

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

MIA-11Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

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

MIA-12Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

MIA12 is the old capital amount.

MIA-13Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

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

MIA-14Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

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

MIA-15Quantity

Decimal number (R)

Optional

1

15

1

Numeric value of quantity

MIA15 is the cost report days.

MIA-16Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

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

MIA-17Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

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

MIA-18Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

MIA18 is the indirect teaching amount.

MIA-19Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

MIA19 is the professional component amount billed but not payable.

MIA-20Reference Identification

String (AN)

Optional

1

50

1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

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

MIA-21Reference Identification

String (AN)

Optional

1

50

1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

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

MIA-22Reference Identification

String (AN)

Optional

1

50

1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

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

MIA-23Reference Identification

String (AN)

Optional

1

50

1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

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

MIA-24Monetary Amount

Decimal number (R)

Optional

1

18

1

Monetary amount

MIA24 is the capital exception amount.