Reminder Regarding Present on Admission Indicator

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.