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State-Specific Guidelines

Here are reimbursement guidelines for medical practitioners in Arizona, California, New Jersey and Texas.

Arizona

California

New Jersey

New Jersey Provider Appeal Procedure (PDF)
New Jersey Department of Banking and Insurance Health Care Provider Application to Appeal a Claim Determination (PDF)
New Jersey: Extension of Benefits
New Jersey: Present on Admission Indicator Code
“Present on Admission” (POA) indicator codes are required to help determine appropriate Diagnosis Related Grouping (DRG) assignments and pricing. A POA code indicates whether the corresponding diagnosis was present at the time of admission.

Keep in mind that:

The code is required for both Commercial and Medicare lines of business.
This requirement has been in effect since 10/1/2008.
A POA code is required for all primary and secondary diagnosis codes; however, a POA code is not needed for the admitting diagnosis code.

See the table below for a list of POA indicator codes.

Value in the POA Field	Meaning
Y	Diagnosis was present at the time of inpatient admission
N	Diagnosis was not present at the time of the inpatient admission
U	Documentation insufficient to determine if condition was present at the time of inpatient admission.
W	Clinically undetermined. Provider unable to clinically determine whether the condition was present at the time of the inpatient admission.
1 or Spaces	Unreported/not used. Exempt from POA reporting.