MOA Outpatient Adjudication

Opt

AtMax 1

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

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	954	Percentage as Decimal	Opt	Decimal	1/10	AtMax 1
2	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
3	127	Reference Identification	Opt	Alphanumeric	1/80	AtMax 1
4	127	Reference Identification	Opt	Alphanumeric	1/80	AtMax 1
5	127	Reference Identification	Opt	Alphanumeric	1/80	AtMax 1
6	127	Reference Identification	Opt	Alphanumeric	1/80	AtMax 1
7	127	Reference Identification	Opt	Alphanumeric	1/80	AtMax 1
8	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
9	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1

ID954

NamePercentage as Decimal

LengthMin 1 / Max 10

Position1

RequirementOpt