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Back  RFI # 2125: PLB03 Levy qualifier

Formal vs. Informal Help Informal Formal


Barber Meg


State and federal law requires payer to off set payments to providers for money owed. When a provider is to receive payment for claims submitted the check for those claims will have funds withheld to off set the Levy/garnishment imposed by state or federal agencies. The PLB qualifiers are not entirely clear to define what should be used for these conditions: Asking for advisement on what qualifier should be used for each condition in the PLB03-1: *Levy IRS 668A short term – federal taxes owed *Levy IRS 668W long term - federal taxes owed *Levy FTB California Franchise Tax Board – CA state taxes owed *Levy EDD Employment Development Dept – some state tax owed; part of the Labor and Workforce Development Agency of the executive ranch of the State of California. *Garnish due to Child Support
*Writ of Garnishment – an overarching writ from the court stating recipient owes money and it to be taken out of the payment *Garnish due to Spousal Support *Garnish due to Dependent Support

Submitter Assigned Keywords

Levy Garnish


In the 835 5010X221A1 TR3 there are 3 possible options to use in the PLB01-1 Adjustment Reason Code:

LE - Levy (with note that reads: IRS Levy)

If the levy/garnishment is related to a federal IRS related adjustment, then adjustment reason code LE should be used.

IR - Internal Revenue Service Withholding

This adjustment code pertains to Federal taxes the provider would decide to have withheld from checks and does not equate to an IRS Levy.

WU - Unspecified Recovery (with a note that reads: Medicare is currently using this code to represent penalty collections withheld for the IRS (an outside source))

The code note on WU is specific to Medicare use, but that doesn't stop this code from being used for purposes like a State Levy, if a health plan so chooses.

If the levy is not associated with the above adjustments, then Adjustment Reason Code: CS Adjustment should be used with the specific condition reported in the PLB03-2.

In all cases, it is highly recommended to use the PLB03-2 Reference Identification to further define the specific condition (for example, 668A short term – federal taxes owed) to clarify to the provider the purpose of the adjustment.
Submission 2/9/2016
Status Date 7/25/2016
Status F - Final
Primary References
Document 005010X221
Set ID835
Segment Position0100
Segment IDPLB
Element Position03
Component Position01
Industry Nameadjustment identifier