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Back  RFI # 2289: NPI value in PLB for interest

Formal vs. Informal Help Informal Formal

Submitter

Heather Morgan

Description

Interest (L6): Which NPI to put in the PLB01 when there is a Payee NPI in the N1 and one or more Service NPI(s) in the NM1*82? Should the payer send the payee NPI or the service provider(s) NPI in the PLB01?

REFERENCES:
-1.10.2.9: 'Convey the net for all claims..'
-NM1 (TR3 Note): 'provided to facilitate identification of the claim..
-PLB (Sit Rule): 'required when reporting adjustments to the actual payment that are NOT specific to a particular claim or service'

EX1:
N1*PE*PAYEE*xx*NPI A
CLP*xxxxxxxxxx*1*xxx*xxx*xx*xx*CLAIM 1*11*1
NM1*82*2*SERVICE PROV 1*****XX*NPI B
AMT*I*21.00
CLP*xxxxxxxxxx*1*xxx*xxx*xx*xx*CLAIM 2*11*1
NM1*82*2*SERVICE PROV 2 *****XX*NPI C
AMT*I*12.00
PLB*NPI A*20181231*L6*-33

OR

EX2:
N1*PE*PAYEE*xx*NPI A
CLP*xxxxxxxxxx*1*xxx*xxx*xx*xx*CLAIM 1*11*1
NM1*82*2*SERVICE PROV 1*****XX*NPI B
AMT*I*21.00
CLP*xxxxxxxxxx*1*xxx*xxx*xx*xx*CLAIM 2*11*1
NM1*82*2*SERVICE PROV 2 *****XX*NPI C
AMT*I*12.00
PLB*NPI B*20181231*L6*-21
PLB*NPI C*20181231*L6*-12

Submitter Assigned Keywords

ERA 835 NPI PLB L6 N1 NM1 PLB01 payee service

Response

The PLB – Provider Adjustment segment is “Required when reporting adjustments to the actual payment that are NOT specific to a particular claim or service. If not required by this implementation guide, do not send.” The purpose of the PLB is to make adjustments to provider payments; however, the TR3 does not explicitly address which level of identifier (Loop 1000B, Loop 2100, or Loop 2110) should be used in PLB01.

Recommendation

X12 recommends including specific information about PLB identifiers in trading partner agreements and/or companion guides to clearly articulate what level of identifiers (Loop 1000B, Loop 2100, or Loop 2110) will be reported in the PLB.
Submission 5/10/2018
Status Date 7/6/2018
Status F - Final
Primary References
Document 005010X221A1
SectionSUMMARY
Page217
Set ID835
Table3
Segment Position0100
Segment IDPLB
Element Position01
Industry NamePROVIDER ADJUSTMENT