Manage Diagnosis Present on Admission Flag

Typically, the system will generate the Diagnosis Present of Admission Flag (POA) field with one of the four options below.

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

However, this rule can be implemented to manage those flags by displaying Y for Yes or using the information included within the patient's profile. 

Workflow

Let's review how to create a claim rule to manage the diagnosis present on admission flags!

• 1. 1. Navigate to Management Center > Claim Rules.
        
        
     2. Click Create Claim Form  Rule.
        
     3. Select the Practice.
        
     4. Next, give the rule a name.
     5. Update the Claim Type to Institutional.
        
     6. Select Conditions to create criteria a claim should meet before the rule will apply.
        
     7. Next, click on the Behaviors dropdown.
     8. Select Diagnoses - Present on Admission flags.
        
     9. Next, click Add.
        
     10. Update the dropdown to one of the following:
         1. Always "Yes" to always use the Y flag.
         2. Use Patient Profile to use the information  in the Behavioral Service Diagnoses section of the patient's treatment episode. 
            
     11. To create multiple behaviors, repeat steps 7-10.
     12. Click Save to complete the process.
          

Box Number(s)

• UB-04: Box 67a-q - ICD-10 Diagnosis Codes
• CMS-1500: N/A

Helpful Hints

• For more information about managing the diagnosis codes within the patient's treatment episode, click here. 
• If one of your conditions is payer-based, select Current Sequence Behavioral instead of the Primary Behavioral Payer. This will ensure the rule applies to secondary and tertiary claims when needed. 
• 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.