Skip to main content
Shop Plans Learn more about our coverage options including health, Medicare, dental and vision options for you, your family or your employees. Get Started Individual & Family Medicare Employer Vision Dental International Travel Find Care FAQ Blog Members Stay on top of your health care with helpful member resources. Members Home Medicare Health Dental Vision Find Care Member Knowledge Center Member Forms Medicare Forms Library Make a Payment Federal Employees Student Blue Healthy Blue Providers Access tools, policies and the latest information to help you care for our members. Providers Home Network Participation Networks & Programs Claims, Appeals & Inquiries Prior Authorization Services & CPT codes Prescription Drug Search Policies, Guidelines & Codes Provider News Provider FAQ Contact Us Employers Learn about our coverage options for small and large employers, and access tools and resources for your group. Employers Home Shop Employer Plans Employer Portal Support Member Forms & Resources Find Care Blog Agents Access the tools you need: rate quotes, applications, forms, the latest industry news, marketing materials and more. Agents Home Agent Services Check Eligibility Find Care Member Forms & Resources Medicare Forms Library
Contact Us
Log In
I am ... Please select A member A provider An employer An agent
Log in to Agent Services
Log in to Employer Services Register for Employer Services I'm registered but need portal access
Username Forgot username? Continue to Log In Register for Blue Connect Need help? Learn how to log in.
Log in to Blue e Register for Blue e Log in to Dental Blue
Back
Reminder Regarding Present on Admission Indicator February 23, 2022 Claims & Coding Blue Card

Feb. 23, 2022 Update: The effective date for the present on admission indicator (POA) has been moved to Mar. 02, 2022.

In October 2021, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) posted a policy regarding present on admission (POA) indicator being required on claims for an effective date of November 30, 2021.

Effective February 26, 2022, provider’s claims will be returned if the present on admission (POA) indicator is not included on the claim submitted. The providers will see an impact on the following claims submissions: 837 Institutional, Blue e UB04 and Paper UB04 claims. A present on admission (POA) indicator will be required along with the diagnosis code.

Please pay special attention to the following statement in the policy document:

Clarifying statements added to Reimbursement Guidelines section “All providers, including, but not limited to inpatient psychiatric hospitals, critical access hospitals, or other facilities granted CMS exemption status, are subject to POA, HAC, and Never Event editing.”

This edit applies to Principal, Additional and External cause of injury.  The indicator should be included in the 837 Institutional Loop 2300, HI segments (ABK, ABF and ABN).  For the Blue e UB04 and UB04 paper submission, the indicator should be included in fields/form locators (FL67, FL67A-X and FL72 A-C).  The indicators are as follows: 

Y=Yes, (present at the time of inpatient admission) 

N=No (not present at the time of inpatient admission) 

U=Unknown (Documentation is insufficient to determine if condition was present at the time of admission) 

W= Clinically undetermined (Provider is unable to clinically determine whether condition was present on admission) 

The 837 Institutional edits will be as follows: 

  • I-366: POA required for inpatient claims.   

Blue e edits for UB04 will be as follows:   

  • 6710 and 7210: POA required for inpatient claims.   

The Blue Cross NC 837 Institutional Companion Guide has been updated to re-introduce the I-366 edit.  

This edit applies to the following lines of business: Commercial, Administrative Services Only (ASO) and Blue Card Inter-Plan Program. This edit does not impact the Federal Employee Plan (FEP), Medicare Supplement, or Medicare Advantage lines of business. 

If you have any questions or concerns, please contact the eSolutions HelpDesk at 888-333-8594, Opt# 1 or by email at edicussup@bcbsnc.com