Monday, March 28, 2011

correct POS list for professional claims in hospital setting

Using the Correct Place of Service Code for Professional Component Claims Rendered in a Hospital Setting

Due to different referral and authorization requirements based on where services are rendered, it is important that your claim is submitted with the correct Place of Service code. The Place of Service code also affects how your claim is routed and which authorization/referral is utilized.
Please verify whether the Member was in the Emergency Room, admitted on an inpatient basis, or if he or she received outpatient services and submit the claim with the corresponding Place of Service code. When the incorrect Place of Service code is submitted, your claim may be denied due to “no authorization.” For example, if a claim is incorrectly submitted with an inpatient Place of Service code, and the Member was in the Emergency Room, there would not be an inpatient authorization on file. Therefore, your claim would be denied due to “no authorization.”

Please utilize the correct Place of Service code from the list below:

Code   Description                                          
11       Office

12       Home

15       Mobile diagnostic unit

20       Urgent care facility

21      Inpatient hospital

22     Outpatient hospital

23     Emergency room hospital

24    Ambulatory surgical center

25    Birthing center

26    Military treatment facility

31   Skilled nursing facility

32   Nursing facility

33   Custodial care

34   Hospice

41   Ambulance – land

42   Ambulance – air or water

51   Inpatient psychiatric facility

52   Psychiatric facility partial hospitalization

53   Community mental health center

54   Intermediate care facility/mentally retarded

55   Residential substance abuse

56   Psychiatric residential treatment center

61   Comprehensive inpatient rehabilitation facility

62   Comprehensive outpatient rehabilitation facility

65   End-stage renal disease facility

71   State or local public health clinic

72   Rural health clinic

81   Independent lab

99   Other unlisted facility

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