AmeriHealth follows and enforces industry standards for claims processing, including the present on admission (POA) indicator billing requirements and claims processing policies for acute care hospitals. Claims processed without a valid POA indicator (as applicable) will be rejected. Except for the exempt facility types listed below, all hospitals are required to follow instructions from the Centers for Medicare & Medicaid Services (CMS) regarding identification of the POA indicator for all diagnosis codes for inpatient claims submitted on the UB-04 and ASC X12N 837 Institutional (837I) claim forms.
Change to billing requirements
CMS modifies diagnosis and procedure codes (including POA indicators) annually, and the number of these modifications has increased as a result of the implementation of ICD-10. To avoid disruption in claim reimbursement due to the increase in modifications, effective October 1, 2017, AmeriHealth will require acute care hospitals to bill claims with the applicable ICD-10 diagnosis and procedure codes — including applicable POA indicator — that apply as of the date of the hospital admission.
Please ensure that your Information Systems department and/or your software vendor are aware of this updated requirement to reduce rejections and/or claim denials.
Exempt facility types
Consistent with CMS, the following facility types are exempt from POA indicator requirements:
- critical access hospitals
- long-term care hospitals
- cancer hospitals
- children?s inpatient facilities
- inpatient rehabilitation facilities
- psychiatric hospitals
For more information
If you have any questions about a claim, please use the NaviNet® web portal to access self-service tools, such as Claim Investigation and Claim Status Inquiry. User guides are available in the NaviNet Resources section and have detailed instructions on how to use these transactions.
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