To convey provider level adjustment information for debit or credit transactions such as, accelerated payments, cost report settlements for a fiscal year and timeliness report penalties unrelated to a specific claim or service
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
PLB01 is the provider number assigned by the payer.
Date (YYMMDD)
PLB02 is the last day of the provider's fiscal year.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
PLB03 is the adjustment information as defined by the payer.
Monetary amount
PLB04 is the adjustment amount.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
PLB05 is the adjustment information as defined by the payer.
Monetary amount
PLB06 is the adjustment amount.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
PLB07 is adjustment information as defined by the payer.
Monetary amount
PLB08 is the adjustment amount.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
PLB09 is adjustment information as defined by the payer.
Monetary amount
PLB10 is the adjustment amount.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
PLB11 is adjustment information as defined by the payer.
Monetary amount
PLB12 is the adjustment amount.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
PLB13 is adjustment information as defined by the payer.
Monetary amount
PLB14 is the adjustment amount.
