PLB Provider Level Adjustment

To convey provider level adjustment information for debit or credit transactions such as, accelerated payments, cost report settlements for a fiscal year and timeliness report penalties unrelated to a specific claim or service

Position: PLB-01 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

PLB01 is the provider number assigned by the payer.

Position: PLB-02 · Element: 373 · Name: Date · Type: Date (DT) · Requirement: Mandatory · Min: 6 · Max: 6 · Repeat: -

Date (YYMMDD).

PLB02 is the last day of the providers fiscal year.

Position: PLB-03 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

PLB03 is the adjustment information as defined by payer.

Position: PLB-04 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Mandatory · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

PLB04 is the adjustment amount.

Position: PLB-05 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

P0506: If either PLB-05 or PLB-06 is present, then the other is required

PLB05 is the adjustment information as defined by payer.

Position: PLB-06 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

PLB06 is the adjustment amount.

Position: PLB-07 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

P0708: If either PLB-07 or PLB-08 is present, then the other is required

PLB07 is adjustment information as defined by payer.

Position: PLB-08 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

PLB08 is the adjustment amount.

Position: PLB-09 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

P0910: If either PLB-09 or PLB-10 is present, then the other is required

PLB09 is adjustment information as defined by payer.

Position: PLB-10 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

PLB10 is the adjustment amount.

Position: PLB-11 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

P1112: If either PLB-11 or PLB-12 is present, then the other is required

PLB11 is adjustment information as defined by payer.

Position: PLB-12 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

PLB12 is the adjustment amount.

Position: PLB-13 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

P1314: If either PLB-13 or PLB-14 is present, then the other is required

PLB13 is adjustment information as defined by payer.

Position: PLB-14 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

PLB14 is the adjustment amount.