Claim Form Rule - Managing Diagnoses Present on Admission Flags

  • Updated

What claim change is needed?

Manage the diagnoses "present on admission" (POA) flags for diagnosis codes. 

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Diagnoses code POA flags options are below:

  • Y - Yes
  • N - No
  • W - Clinically Undetermined
  • U - Unknown

Box Number

UB-04: Box 67a-q - ICD-10 Diagnosis Codes

CMS-1500: n/a

Steps

  1. Navigate to Management Center > Claim Rules
  2. Click "Create Claim Form Rule".
  3. Select the practice.
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  4. Name the claim rule.
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  5. Set Claim Type to "Institutional".
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  6. Set Conditions for claim rule to meet.
  7. Under Available Behaviors, select "Diagnoses - Present on Admission flags". mceclip2.png
  8. Click Add. 
  9. Select "Always Yes" to always show a "Y" for the claim rule conditions.
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    Or, select "Use Patient Profile" to use the diagnosis POA flags from the Patient > Intake > Behavioral Service Diagnoses tab.
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  10. Click Create.

Related Articles

Add Diagnoses Codes

To read more about how to set claim rule conditions and order, see the Claim Rule: Setting Claim Rule Conditions article.

To read more about how to set up a claim rule to be effective as of a certain date, see the Scheduled Change Sets article.

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