PER CMS Guidelines, Blue Shield of California is currently accepting Electronic Claims. Using the 837I, submit the POA indicator in segment K3 in the 2300 loop, data element K301.
Refer to the following tables for more information:
POA: "POA" is always required first, followed by a single indicator for every diagnosis reported on the claim.
Y: The principal diagnosis is always the first indicator after "POA." In this example, the principal diagnosis was present on admission.
N: The first secondary diagnosis was not present on admission, designated by "N."
U: It was unknown if the second secondary diagnosis was present on admission, designated by "U."
W: It is clinically undetermined if the third secondary diagnosis was present on admission, designated by "W."
1: The fourth secondary diagnosis was exempt from reporting for POA, designated by "1."
Sample 1: POA indicators for an electronic claim with one principal and five secondary diagnoses should be coded as POAYNUW1YZ
Sample 2: POA Indicator for an electronic claim with one principal diagnosis without any secondary diagnosis should be coded as POAYZ
POA: "POA" is always required first, followed by a single indicator for every diagnosis reported on the claim.
Y: The principal diagnosis is always the first indicator after "POA." In this example, the principal diagnosis was present on admission.
Z: The letter "Z" is used to indicate the end of the data element.
Current inbound samples:
K3*POANYZ~
K3*POAYYYYYYYYY1Z~
K3*POAYYYNYYYYYYYYYYYYYY111111Z~
ERA/EFT frequently asked questions
ERA is an electronic transaction that enables providers to receive claims payment information electronically. Files are transmitted in the HIPAA-mandated ASC X12 835 4010 A1 format.