What is a PLB reason code?

Provider-Level Adjustment (PLB) reason codes describe adjustments. the Medicare Contractor makes at the provider level, instead of a. specific claim or service line.

What does PLB mean in medical billing?

Provider-Level Balance
Provider-Level Balance (PLB) Page 1. Provider-Level Balance (PLB) Supplement to the Electronic Remittance Advice 835 Transaction Companion Guide. The PLB segment is used to transmit information about Provider-Level Adjustments – that is, payments and debts that are not specific to a particular claim or service.

What is reason code C5?

C5. Temporary Allowance, Non PIP SNF Settlement Payment. CS. Adjustment; child support, alimony, reissued invoice etc.…

What does FCN mean on Medicare EOB?

For claim adjustments where payment was made to the provider on the original and the adjusted claim, this amount will be the lower paid amount of the original claim or the adjusted claim. The Medicare ID on the original claim will display with the Financial Control Number (FCN).

How do I get a copy of my Medicare Remittance Advice?

The option to request a duplicate remittance is available through the Claim Status function. Instructions for navigating the IVR are available on our website. Providers who do not have a WPS GHA Portal account or who need a duplicate copy of only a single claim should request one by phone through the IVR.

What are provider level adjustments?

A Provider Level Adjustment is an option in MacPractice when addressing Insurance Payments where you can credit some or all of an insurance payment to a specific Provider. Once the payment is saved and applied, an additional line will be posted to the ledger describing the Provider Credit from an Insurance Overpayment.

What does PLB stand for?


Acronym Definition
PLB Personal Locator Beacon (see SARBE)
PLB Phospholamban (cardiac calcium regulation)
PLB Productivity Linked Bonus
PLB Processor Local Bus (high-performance, on-chip bus)

What is withhold amount in medical billing?

5 Withhold – Means a percentage of payment or set dollar amounts that are deducted from the payment to the physician. group/physician that may or may not be returned, depending on specific predetermined factors.

What does J1 mean on a Medicare remit?

J1. Non-reimbursable – Used to offset claim or service level data that reflects what could be paid if not for demonstration programs or other limitation that prevents issuance of payment. For example, this is used to zero balance provider payment for Centers of Excellence and Medicare Advantage RA s.

What does adjustment code FB mean?

Forward Balance
Forward Balance (FB) The FB amount does not indicate funds have been withheld from the provider’s payment for this remittance advice. It only indicates that a past claim has been adjusted to a different dollar amount.

What does denial code MA01 mean?

Initial Part B determination
MA01 (Initial Part B determination, Medicare carrier or intermediary)–If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the review.

What does PLB stand for in Medicare Part A?

Provider-Level Adjustment (PLB) reason codes describe adjustments the Medicare Contractor makes at the provider level, instead of a specific claim or service line.

When to use PLB codes in remittance advice?

At the provider level, adjustments are usually not related to any specific claim in the remittance advice, and Provider Level Balance (PLB) reason codes are used to explain the reason for the adjustment.

When is the reversal and corrected claim reported in the PLB Wo?

The 835 transaction that contains the reversal claim will report a negative value in the PLB WO. The 835 transaction that contains the corrected claim will report a positive value in the PLB WO. • When the reversal and corrected claim are reported in the same 835 transaction, no PLB is reported.

What happens when Medicare changes the procedure code?

When Medicare changes a procedure code while processing a claim, the procedure code under which the service was paid is displayed in the PROC field, followed by modifier CC (Code Change). The procedure that had originally been submitted is entered in parentheses directly under the paid procedure code.