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Back  RFI # 580: PLB - WO vs. FB

Formal vs. Informal Help Informal Formal

Submitter

Jodi Fekete

Description

What is the difference between FB and WO and when would you use each in overpayment recovery situations. NJ law that says we have to give the providers a certain number of days to satisfy their A/R prior to us taking the money back. This is how I see we can satisfy that requirement. Please let me know if there should be a reason we use the WO instead of FB in the 2nd portion of this.

Day 1 (when realization that there was an error)
Check #1573 Check amount = $0
Detail shows reversal of $100.00 (no correction – paid wrong provider). No other transactions on this check/835.

PLB*9999999999*20071231*FB:1573*-100!
Where PLB01 = NPI; PLB02 = end of provider’s fiscal year; PLB03-1 = Adjustment Identifier; PLB03-2 = reference identifier (check number); PLB04 = dollar amount

Day 55: (when we can recover the A/R)
Check #1777 Check amount = $50, total payments = $150, fully satisfies A/R

PLB*9999999999*20071231*FB:1573*100!

Submitter Assigned Keywords

835 PLB

Response

The use of adjustment code FB is to recoup money and there is no money left to be recouped in that remittance. The recoupment is moved to a future remittance. This is for money that is not claim specific. The use of adjustment code WO is to adjust for overpayments made to previous claim payments. The process of a Reversal and Correction is used to correct the payment but may result in money owed to the payer. If the current remittance cannot account for this overpayment the PLB is used.

Recommendation

The 5010 835 X221 TR3 has extended front matter sections (1.10.2.12 and 1.10.2.17) that offer more detailed explanation for these situations. The information in these sections is 100% compatible with the codes and instructions in guide 004010X091.
Submission 7/24/2007
Status Date 11/29/2007
Status F - Final
Primary References
Document 004010X091A1
SectionPLB03
Page99
Set IDPLB03