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Back  RFI # 2179: 835 for notification only

Formal vs. Informal Help Informal Formal

Submitter

Ronny Biderman

Description

We have a payer issuing an 005010X221A1 version of an 835 with the following BPR segment
"BPR*H*0*C*NON************20141214~"
That is followed by adjudication information for 18 claims and a PLB segment listing the following
"PLB*NO CHECK*20141231*FB*-36303.14~"
The total on the PLB matches the summed total of paid amount(CLP04) of the 18 claims.
Does this mean
A-This is informational only and they are notifying you of future intention of adjudicating this claim and issuing new 835 records for all 18 claims.
B-The total of this batch of claims is negative therefore we are forwarding the balance to offset future payments and these claims will not be adjudicated again.
Thank you,

Submitter Assigned Keywords

PLB FB INFORMATIONAL

Response

Choice B is the correct interpretation. The value in the PLB03-1 is equal to “FB” which is defined as a forward balance. The negative value in the PLB04 represents a balance moving forward to future payment. See section 1.10.2.12 Balance Forward Processing for additional information on processing forward balance amounts
It should be noted that the PLB segment did not contain a value in the PLB03-2. This data element is required when the PLB03-1 is FB for tracking purposes. In addition the PLB01 should contain the provider’s identification not the phrase “NO CHECK”
Submission 11/2/2016
Status Date 12/29/2016
Status F - Final
Primary References
Document 005010X221
Section2.4
Page70