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Anthem BCBSMedicaid · Documentation · Claims & Billing · OHHigh impact

[Ohio] Check Present on Admission indicators to support accurate claim processing

Effective date
Jan 1, 2027
Identified
Oct 2, 2026

Summary

Beginning January 1, 2027, Anthem Blue Cross and Blue Shield Medicaid in Ohio will implement prepayment claim edits to validate Present on Admission (POA) indicators on inpatient facility claims. Claims with missing, inconsistent, or invalid POA information will not be eligible for reimbursement. Billing teams must audit POA reporting on all applicable diagnoses before claim submission to ensure accurate indicator assignment.

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What to do

Action · 8 steps
01Before January 1, 2027: Billing team must conduct a comprehensive audit of POA indicator practices and update billing workflows to validate POA reporting on all inpatient facility claims submitted to Anthem Blue Cross and Blue Shield Medicaid in Ohio.
02Verify that diagnoses exempt from POA reporting do not have non-exempt POA indicators assigned.
03Ensure all diagnoses subject to POA reporting include a valid non-exempt POA indicator.
04Confirm that non-exempt diagnoses do not have exempt POA indicators.
05Update claim submission processes, billing software validation rules, and provider encounter forms to include POA accuracy checks before transmission.
06Train billing staff to identify and correct POA errors during claim preparation.
07Failure to submit claims with accurate POA indicators will result in claim denials and non-reimbursement.
08Contact Anthem via Availity Chat with Payer (https://Availity.com) during business hours for questions about POA requirements specific to diagnosis codes.

Original notice

[Ohio] Check Present on Admission indicators to support accurate claim processing
providernews.anthem.com · Always check the source before changing claims.
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