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Back  RFI # 484: PLB03-2 Reference Identifier

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Submitter

Kellene Parthemore

Description

My question is, What is the industry standard for reporting the reference identification for an authorized return in the PLB03-2 data element? We use the 72 reason code, and then use the internal claim number from the CLP07 for the reference Identification *72>1234567*. Is it standard to use the claim number as the reference identification or do more payers/providers use the patient account number from the CLP01 data element? Or is there another reference identification that is used?

Response

The contents of PLB03-2 (or any related identification PLB element) depends upon the business situation. If the authorized return was the result of a letter to the provider that contained a financial control number, that belongs in PLB03-2. If there is no financial tracking number on the payer correspondence to the provider then the WG recommends including a combination of CLP01 and CLP07 or use only one of these elements, if available.

Recommendation

See the explanation of claim overpayment recoveries in the most current 835 implementation guide - 005010X221 - for additional explanation and guidance. See section 1.10.2.17 (Claim Overpayment Recovery).
Submission 11/15/2006
Status Date 3/14/2007
Status F - Final
Primary References
Document 004010X091A1
Section3.1
Page170
Set IDPLB
Table3
Segment Position010
Segment IDPLB
Element Position03
Component Position2