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Back  RFI # 2202: PLB L6 interest

Formal vs. Informal Help Informal Formal

Submitter

Barber Meg

Description

We have business condition where in a given remit the claims report AMT*I for interest however the interest payment is not included in the check associated to those claims (no PLB = L6). The interest is included in another remit (out of a different bank account). So remit 1 has claims with AMT = I but no PLB interest payment and remit two does not have any claims with interest but has interest payment related to claims in Remit 1 and has to have a PLB. Per the TR3 when you have AMT I you must have supporting PLB with L6 and vice versa.
How should the remit 1 PLB be structured for informational purpose to say payment in subsequent check and how should remit 2 be structured for the PLB as we can't use L6 as qualifier?

Submitter Assigned Keywords

PLB L6 AMT*I

Response

In the scenario you provided your “remit 1” is not compliant with the 005010X221A1 TR3. The Situational Rule of the Loop 2100 AMT – Claim supplemental Information segment states. “Required when the value of any specific amount identified by the AMT01 qualifier is non-zero. If not required by this implementation guide, do not send." It is not compliant with the TR3 to send an AMT01 equals “I” when the remittance does not include an interest payment. Also, the PLB – Provider Adjustment segment is not designed to provide information related to a subsequent payment.

It is the payer's responsibility to ensure that all necessary funds to support the provider's remittance are reported in only one 835 and associated check or EFT. Use of multiple bank accounts is an internal issue to the payer.
Submission 3/2/2017
Status Date 6/7/2017
Status F - Final
Primary References
Document 005010X221
Section1.10.2.9
Page31
Set ID835
LoopPLB
Segment IDPLB
Element Position03
Component Position-1
Industry NameAdjustment Reason code