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The XYZs of PLB Codes
October 21, 2021
Provider Level Balance adjustment codes (commonly known as PLBs or PLB codes) provide information about provider level adjustments, which are payments or debts unspecific to a patient’s claim or service. PLBs are included on electronic remittance advice (ERA, also known as 835 files or remittances) when an adjustment is needed, however, not every remittance will include PLB adjustments. These adjustments increase or decrease the payment and in the case of a PLB, decreasing the payment would be a positive number and increasing it would be a negative number. The following example illustrates how a PLB would appear in an 835 file:
The electronic funds transfer (EFT) amount, the claim payment amount, and the provider level adjustment amount must all balance out in the 835. PLB adjustment codes assist in telling what a PLB segment is indicating.
Fawkes Health’s CAMS application streamlines the handling of routine PLB adjustment codes with our remittance workflow and App Batch feature. CAMS will automatically recognize when a PLB code is present on a remittance that has been ingested into CAMS and automatically matched to the corresponding payment. For routine PLB codes, CAMS is capable of automating the general ledger (GL) posting process with the App Batch feature. For example, when a remittance is loaded into CAMS and contains the PLB code ‘L6’ (interest), CAMS leverages automation to recognize this PLB code and corresponding amount, then create a journal entry to a specific GL account in the GL system that is interfaced with CAMS - without human intervention.
There are many possible PLB adjustment codes that can be included in remittances. Below is a table which references some of the more common examples of PLB adjustment codes, as well as the code definition and a brief description.
| PLB Adjustment Code | Definition | Description |
|---|---|---|
| AH | Claim Transmission Fee Amount | Transmission fees that are not specific or dependent on individual claims |
| B2 | Rebate Amount | Amount for an authorized return |
| BD | Bad Debt Amount | Notates a debt that cannot be collected |
| BN | Bonus Amount | Refers to bonus payments to providers |
| C5 | Temporary Allowance | Refers to a tentative settlement |
| CS | Adjustment | Notates a reissued payment |
| E3 | Withholding Amount | The amount withheld from payments |
| FB | Forward Balance | Reflects a balance being moved forward to a future remittance |
| IR | Internal Revenue Service Withholding | IRS tax withholding |
| J1 | Non-Reimbursable | When the service provider requests the balance be applied to the group medical plan as opposed to the claim |
| L3 | Penalty Amount | Withheld due to a penalty |
| L6 | Interest Amount | Interest paid |
| LE | Federal Payment Levy | Internal Revenue Service Non-1099 Withholding Amount |
| OB | Affiliated Provider(s) Offset Amount | The offset for the service provider’s amount |
| PI | Periodic Interim Payment (PIP) | Lump sum amount |
| WO | Overpayment Recovery Amount | An overpayment is recouped from the service provider |
| WU | Federal Payment Levy | Non-Internal Revenue Service Withholding Amount Related to a Federal Payment Levy Program |
| 72 | Authorized Return | Notates a balance has been returned by the service provider or a voided check |
Information was sourced from: Centers for Medicare & Medicaid Services, Novitas Solutions,
https://x12.org/codes/provider-adjustment-reason-codes
←The Ins and Outs of 835s
November 30, 2021