MedicaidDocumentationHigh impact
Newsletter Vol. 23, No.07
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid clarifies Present on Admission (POA) indicator requirements and Healthcare Acquired Condition (HAC) reporting for non-acute hospitals and HMOs. Providers must now distinguish between occurrence span codes '74' (transfer to acute hospital for HAC treatment) and '77' (non-acute facility managed HAC treatment), and include these codes with corresponding date spans on claims containing POA indicators of 'N' or 'U', or claims will be denied.
Action Required
By July 1, 2012 (retroactive - URGENT REVIEW REQUIRED): Billing team must immediately audit all non-acute hospital inpatient claims submitted since July 2012 to ensure compliance. (1) Verify that all claims containing POA indicators of 'N' or 'U' include occurrence span code '74' (for acute hospital transfers related to HAC) or '77' (for non-acute facility-managed HAC) with corresponding date spans. (2) Update claim submission processes to mandate occurrence span codes and date spans whenever POA indicators 'N' or 'U' are reported—missing codes will result in automatic claim denial. (3) Train billing staff to correctly identify and code HAC scenarios: use '74' when patient transfers to acute hospital for HAC treatment; use '77' when non-acute facility manages the HAC. (4) For POA indicator '1' (exempt), verify all diagnosis codes are listed on the 2011 ICD-9-CM Official Guidelines exempt list or claims will be denied. (5) Review all denied claims from July 2012 forward related to HAC/POA reporting and resubmit with corrected occurrence span codes. (6) Contact New Jersey Division of Medical Assistance & Health Services (609-588-2668) for clarification on any retroactive claim adjustments. Failure to comply results in claim denials for inpatient days related to HACs.