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Back  RFI # 1961: PLB Adjustment field lengh

Formal vs. Informal Help Informal Formal

Submitter

Sharon Sieve

Description

Payer sending FB plb adj. 10 characters including decimal example
$1145002.02. the neg sign that determines this should be a pmt not a takeback is not present due to field lengh. Shouldnt the payer send two separate amts totalling the full fb plb amount and include the negative sign in each?
The bpr total includes the plb as a pmt not a takeback. This causes a balancing issue for providers. And a phone call to the payer.
Exa: $45000.00 bpr total
$58184.08 Clp Pmt total
$1145002.02 FB Pmt
-$1158186.10 PI takeback
Is not sending the negative sign required?

Submitter Assigned Keywords

PLB Adj field lenght including the negative sign when needed

Response

Transaction set 835 data element PLB04 is data type decimal. The 005010X221A1 explicitly states in section B.1.1.3.1.2 Decimal, "The length of a decimal type data element does not include the optional leading sign or decimal point." It additionally states for Data Element 782 (The Data Element for PLB04) "... decimal data elements in Data Element 782 (Monetary Amount) will be limited to a maximum length of 10 characters including reported or implied places for cents (implied value of 00 after the decimal point). Note the statement in the preceding paragraph that the decimal point and leading sign, if sent, are not part of the character count." Thus, data element PLB04 may contain an amount up to $99,999,999.99, both positive and negative.

Then, 005010X221A1 section 1.10.2.1.3 Transaction Balancing explicitly states “Within the transaction, the sum of all claim payments minus the sum of all provider level adjustments equals the total payment amount.” So dropping the negative sign from the PLB because of space limitations would violate the transaction balancing requirement, since the CLP04 minus the sum of the PLB adjustments would no longer equal the BPR02.

Recommendation

Review the examples in 005010X221A1 section B.1.1.3.1.2. There is an example that further demonstrates your situation, along with other potential situations.
Submission 8/25/2014
Status Date 2/5/2015
Status F - Final
Primary References
Document 005010X221
SectionSummary
Page223
Set IDplb04
Table3
Segment Positionplb04