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Back  RFI # 1756: Balance Forward Processing

Formal vs. Informal Help Informal Formal

Submitter

Bill Ackerson

Description

According to the TR3 (SEE PAGE 37), a PLB for a Forward Balance can only appear on the 835 when the BPR amount is greater zero. Due to a system limitation, we can only retract money from the Provider based on Line of Business.

Can you please tell us the appropriate way to report the PLB03 Segment. Should we be using a ‘WO’ or a ‘FB’ negative balance?

Any additional information will be appreciated.

Submitter Assigned Keywords

Balance Forward Processing

Response

Based on the assumption that Option 3 of the Overpayment Recovery process described in the 835 TR3 is being used in this situation, the TR3 specifies that "WO" be used with a negative amount to balance the transaction. Subsequently (on a different processing cycle), the balance to be collected is represented by a positive "WO" in the PLB. If the unpaid balance cannot be collected, a negative "FB" for the amount to be collected would be included in the PLB, and the forward balance process (section 1.10.2.17, page 50 of the TR3) must be used.
Submission 2/26/2013
Status Date 4/25/2013
Status F - Final
Primary References
Document 005010X221
SectionSummary
Page217
Set ID835
Table3
Segment IDPLB
Code ValueFB / WO