Section title: Requests for Interpretation
RFI #
2282
Clairifcation of MOA02 segment
Description

I have an example where Medicaid is the payer and the MOA02 segment is populated with a dollar amount. The response to the question RFI #1055 submitted “What is the HCPC payable amount? Is it the sum of all lines?” was “MOA02 is the sum of all paid HCPCS service lines on the claim when not zero.” The 835 data which I have reviewed does not follow that logic. Can you please expand on how the MOA02 segment is determined?

This claim total is $118.00 and based on the MA fee schedule, we would expect a payment of $35 for the procedure code billed. MOA02 is $10.

CLP*XXXXXXXXXXXXXX*4*118.00*0**MC*XXXXXXXX*11~CAS*PI*16*118.00~NM1*QC*1*XXXXX*XXXXX*XJ***
MR*XXXXXXXX~MOA**10.00*N58~REF*EA*XXXXXX~REF*SY*XXXXXXX~DTM*232*XXXXXXXX~DTM*233*XXXXXXXX~

The MOA02 amount does not correspond to the billed services.

CLP*XXXXXXXXXXXXX*4*16290.69*0**MC*XXXXXX*13*1~CAS*PI*16*16290.69~NM1*QC*1*VVVVV*VVV*V***
MR*000000000~MOA**89.46*N58~REF*EA*00000000~REF*SY*00000000~DTM*232*XXXXXX~DTM*233*XXXXXXX~LX*182~

Response

As stated in RFI #1055, the MOA02 is the sum of all paid HCPCS service lines on the claim when not zero.
Since the claims were denied, it appears that there was no HCPCS payable lines and therefore MOA02 should not be reported.

DOCUMENT ID
005010X221