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Back  RFI # 1324: Interest & PLB on 5010 835

Formal vs. Informal Help Informal Formal

Submitter

Shelli Chang

Description

How do we handle reporting a 5010 835 with the reversal & the adjustment in the same transaction, &the net of the interest amts is $0? There was a reversal claim with AMT{I reported for negative interest amt & adjustment claim reported with AMT{I report for interest paid amt but it’s the same amt as the reversal, so net interest is $0.
AMT{I{133.21
AMT{I{-133.21

It seems Front End Edits require PLB03=L6 when the Claim supplemental info (Lp 2110, AMT01) = I for interest. We are told we must use the PLB segment because AMT01=I. However, the note in the 5010 PLB Provider Adjustment segment says “Zero Dollar adjustments are not allowed.” If we build the PLB segment with PLB04=$0, we get a different reject message. How should we handle 835’s where interest amts for the reversal &corrected claim nets 0?

Response

The guide states that PLB segments are required when reporting adjustments to the actual payment that are not specific to a particular claim or service, and that zero dollar adjustments are not allowed. The guide also states that AMT segments are used to convey information only and are not part of the financial balancing of the 835. Since the reversal and correction Interest and any other Interest Amount nets to zero, there is no adjustment to the actual payment for Interest and the PLB must not be used to report any Interest adjustment.

Recommendation

Front-end edits should require the PLB/L6 only when the net interest is non-zero.
Submission 5/25/2011
Status Date 7/22/2011
Status F - Final
Primary References
Document 005010X221
SectionPLB p217
Secondary References
RFI ID 1764
Document 005010X221
Section1.10.2.9