ERA PLB Amounts

Purpose

The ERA PLB Amounts setup window is used in the Automated Payment Posting process. When an ERA is received, it is possible that a Provider Level Adjustment (PLB) segment is provided. This often includes information related to accelerated payments, cost reports settlements, and timeliness report penalties unrelated to a specific claim or service.

The ERA PLB Amounts setup window will allow you to decide exactly how to handle each type of transaction supplied. Some scenarios may require that the money is posted to one to many claims.  Other times, you may just want to ignore it.   

Customizing PLB Segments per Payer

The ERA PLB Amounts setup window serves as the Company Default for how these values are handled in the Payment Posting process.  However, users can customize this at a payer level. This is helpful when different payers treat these standardized values different than the rest of the industry.  Payer level settings will take precedence over the company level setting. This can be done by navigate to Setup > Payers > More > Payer ERA Overrides > PLB.

Screen Layout and Definitions

PLB Adjustment Reason Code List

In the ERA, the PLB Adjustment Reason Code is provided in the 835 EDI FIle (Segment: PLB 03) by the payer.  The guidelines allow the following values:  

CodeDefinition
50Late Charge
51Interest Penalty Charge
72Authorized Return
90Early Payment Allowance
AHOrigination Fee
AMApplied to Borrower's Account
APAcceleration of Benefits
B2Rebate
B3Recovery Allowance
BDBad Debt Adjustment
BNBonus
C5Temporary Allowance
CRCapitation Interest
CSAdjustment
CTCapitation Payment
CVCapital Passthru
CWCertified Registered Nurse Anesthetist Passthru
DMDirect Medical Education Passthru
E3Withholding
FBForwarding Balance
FCFund Allocation
GOGraduate Medical Education Passthru
HMHemophilia Clotting Factor Supplement
IPIncentive Premium Payment
IRInternal Revenue Service Withholding
ISInterim Settlement
J1Nonreimbursable
L3Penalty
L6Interest Owed
LELevy
LSLump Sum
OAOrgan Acquisition Passthru
OBOffset for Affiliated Providers
PIPeriodic Interim Payment
PLPayment Final
RARetro-activity Adjustment
REReturn on Equity
SLStudent Loan Repayment
TLThird Party Liability
WOOverpayment Recovery
WUUnspecified Recovery
ZZMutually Defined

Payment Method Code Values

Because PLB Adjustment Reason Codes do not specific where to post the money or even if you should post the money, the application can not do this automatically.  Therefore, users will be required to decide how to allocate the amount supplied in this segment.  So, by default, every PLB line is considered a Deposit Error.  Users can control what happens with those errors by setting the following options.

  • PLB Type:  Decides how to handle each PLB Code should be handled.
    • Apply Amount to Claims:  If this option is set, PLB amounts will be classified as an error. The user will have to ‘Resolve’ this error by applying the money to existing claims.
    • Report Amount:  If this option is set, the amounts will be flagged so that we can report on the amounts. The error will be ignored. The user does not have to do anything – money does not get posted anywhere.
    • Ignore/Resolve:  If this option is set, the PLB error will be automatically set to ignore. The user does not have to do anything – money does not get posted anywhere.
  • Claim Information:  If the user chooses the 'Apply Amount to Claims' option, these values will be used to determine what happens with the claim that the money is posted to.
    • Claim Status:   Users can determine if the claim status that the money is being posted to should change.  If it should remain as is, leave this field blank.
    • Claim Level:   Users can determine if the claim level that the money is being posted to should change.  If it should remain as is, leave this field blank.
    • Payment:   Users can determine which payment type is associated with the amount when posted.  If it is blank, the user will be required to pick the payment type during the posting process.

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