MIA Inpatient Adjudication

Opt

AtMax 1

To provide claim level data related to the adjudication of inpatient claims

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	380	Quantity	Mandatory	Decimal	1/15	AtMax 1
2	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
3	380	Quantity	Opt	Decimal	1/15	AtMax 1
4	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
5	127	Reference Identification	Opt	Alphanumeric	1/80	AtMax 1
6	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
7	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
8	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
9	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
10	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
11	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
12	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
13	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
14	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
15	380	Quantity	Opt	Decimal	1/15	AtMax 1
16	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
17	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
18	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
19	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
20	127	Reference Identification	Opt	Alphanumeric	1/80	AtMax 1
21	127	Reference Identification	Opt	Alphanumeric	1/80	AtMax 1
22	127	Reference Identification	Opt	Alphanumeric	1/80	AtMax 1
23	127	Reference Identification	Opt	Alphanumeric	1/80	AtMax 1
24	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1

ID380

NameQuantity

LengthMin 1 / Max 15

Position1

RequirementMandatory