2017-42: Reminder to Hospital Providers: POA Indicator
Date: 08/28/17
In an effort to continue to mirror paper claims with enhancements that have been made in the Electronic Data Interchange (EDI) environment, new paper rejects have been created to ensure that providers billing practices are the same in all formats. Based on the current Uniform Billing Editor guidelines, the Present on Admission (POA) indicator of 1 is not a valid reporting element. When a code is exempt from POA reporting, providers are to leave this field blank in version 5010 of the current form code.
Please Note: To remain consistent and meet the expected billing guidelines, effective October 1, 2017, Louisiana Healthcare Connections will begin rejecting paper claims if billed with a POA indicator of 1.
To avoid rejections, please only utilize valid POA indicators in the shaded areas after fields 67 – 67Q on the UB-04.
- N indicating No, the diagnosis was not present at time of inpatient admission
- Y indicating Yes, the diagnosis was present at time of inpatient admission
- U indicating Unknown, documentation insufficient to determine if the condition was present at the time of inpatient admission
- W indicating Not Applicable, clinically undetermined due provider inability to clinically determine whether the condition was present at the time of inpatient admission
- Blank indicating the code is exempt from POA reporting