MedicaidReimbursementHigh impact
Newsletter Vol. 22, No.15
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid will deny reimbursement for inpatient days related to Healthcare Acquired Conditions (HACs) when Present on Admission (POA) indicators show 'N' (not present) or 'U' (insufficient documentation). Claims must use occurrence span code '74' to identify non-payable HAC days.
Action Required
Immediately: Billing team must ensure all inpatient claims for NJ Medicaid patients include accurate POA indicators ('Y', 'N', 'U', 'W', or '1') for all diagnosis codes. Use occurrence span code '74' to identify inpatient days related to HACs with POA indicators of 'N' or 'U' - these days will not be reimbursed. Verify any diagnosis using POA indicator '1' appears on the ICD-9-CM exempt list or claims will be denied.