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
Element
Name
Type
Requirement
Min
Max
Repeat
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
PLB01 is the provider number assigned by the payer.
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year
PLB02 is the last day of the provider's fiscal year.
Code indicating a code from a specific industry code list
C042-01 identifies the reason for the credit or debit adjustment. See Code Source 967.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Monetary amount
PLB04 is the adjustment amount.
Code indicating a code from a specific industry code list
C042-01 identifies the reason for the credit or debit adjustment. See Code Source 967.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Monetary amount
PLB06 is the adjustment amount.
Code indicating a code from a specific industry code list
C042-01 identifies the reason for the credit or debit adjustment. See Code Source 967.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Monetary amount
PLB08 is the adjustment amount.
Code indicating a code from a specific industry code list
C042-01 identifies the reason for the credit or debit adjustment. See Code Source 967.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Monetary amount
PLB10 is the adjustment amount.
Code indicating a code from a specific industry code list
C042-01 identifies the reason for the credit or debit adjustment. See Code Source 967.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Monetary amount
PLB12 is the adjustment amount.
Code indicating a code from a specific industry code list
C042-01 identifies the reason for the credit or debit adjustment. See Code Source 967.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Monetary amount
PLB14 is the adjustment amount.