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:
| Code | Definition |
|---|---|
| 50 | Late Charge |
| 51 | Interest Penalty Charge |
| 72 | Authorized Return |
| 90 | Early Payment Allowance |
| AH | Origination Fee |
| AM | Applied to Borrower's Account |
| AP | Acceleration of Benefits |
| B2 | Rebate |
| B3 | Recovery Allowance |
| BD | Bad Debt Adjustment |
| BN | Bonus |
| C5 | Temporary Allowance |
| CR | Capitation Interest |
| CS | Adjustment |
| CT | Capitation Payment |
| CV | Capital Passthru |
| CW | Certified Registered Nurse Anesthetist Passthru |
| DM | Direct Medical Education Passthru |
| E3 | Withholding |
| FB | Forwarding Balance |
| FC | Fund Allocation |
| GO | Graduate Medical Education Passthru |
| HM | Hemophilia Clotting Factor Supplement |
| IP | Incentive Premium Payment |
| IR | Internal Revenue Service Withholding |
| IS | Interim Settlement |
| J1 | Nonreimbursable |
| L3 | Penalty |
| L6 | Interest Owed |
| LE | Levy |
| LS | Lump Sum |
| OA | Organ Acquisition Passthru |
| OB | Offset for Affiliated Providers |
| PI | Periodic Interim Payment |
| PL | Payment Final |
| RA | Retro-activity Adjustment |
| RE | Return on Equity |
| SL | Student Loan Repayment |
| TL | Third Party Liability |
| WO | Overpayment Recovery |
| WU | Unspecified Recovery |
| ZZ | Mutually 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.
Window Display
