Section title: Requests for Interpretation
RFI #
2646
Negative quantity values in MIA (837)
Description

Currently sending negative values for quantity elements (pos. 01, 03, 15) in 2320/MIA segment is not explicitly restricted in TR3. Is it compliant with TR3 if negative value is submitted in one of these elements? 

Scenario

n/a, trying to figure out if such a scenario exists.

We received such claim (negative value in the MIA segment), what can we do to respond:

Can we send back 277 claim ack with rejection reporting reason as TR3 error/violation? or

Can we send back 277 claim ack with rejection reporting reason as trading partner specific error/violation? Or

Should we accept this claim for further processing?

Basically, can we stop this claim before it gets into back-end system for processing or should we let it through.

RFI Response

The MIA segment in the 837 is required when inpatient adjudication information is reported in the remittance advice (835). There is no language in the 837 or 835 implementation guides that prohibits a negative value in MIA03 or MIA15. Without specific examples/scenario/use cases, X12 cannot comment how to process a negative value. According to the 835 implementation guide, MIA01 must always be zero, therefore zero is the only value allowed in the 837.

X12 cannot comment on a payer or provider’s policy or procedures to accept or reject a file.

DOCUMENT ID
005010X223