Section title: Requests for Interpretation
RFI #
2579
835 RARC - Loop 2100 MIA01
Description

Can MIA01 be used for mapping the RARC code?  Per TR3 - for 835, for MIA - INPATIENT ADJUDICATION INFORMATION - For the 6 CAS Codes - CAS03, CAS06, CAS09, CAS12, CAS15, CAS18, can we use the MIA01, MIA05, MIA20, MIA21, MIA22, MIA23 for RARC codes.  Can the MIA01 be used for RARC code instead of using for Covered Days or Visits Count, and if so, then use QTY segment at the claim level for covered days or visits count?

Scenario

CAS03, CAS06, CAS09, CAS12, CAS15, CAS18 can have the 6 CAS codes.

MIA01, MIA05, MIA20, MIA21, MIA22, MIA23 can have the 6 remark codes.

RFI Response

MIA01 is defined in the 835 implementation guide, “Quantity”, “Covered Days or Visits Count.”  Reporting a RARC in the MIA01 is not compliant with the with the definition of this data element.

The 5010 835 implementation guide does not support more than 5 RARC codes at the 2100 level.  In subsequent versions of the TR3 guide, the 2100 RAS segment allows for more than 5 RARC codes.

DOCUMENT ID
005010X221