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Provider Adjustment (PLB) - Registry Setting

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Avatar MSO > Claims Processing > HIPAA Health Care Claims > 835 Outbound > Provider Adjustment (PLB)

'Y' enables the following fields in the Contracting Provider 835 Defaults, Create EOB, and Other EOB Information forms:

  • Fiscal Period Date (PLB-02)
  • Adjustment Reason Code (PLB-03-01)
  • Provider Adjustment Identifier (PLB-03-02)
    These fields include the Provider Adjustment (PLB) segment for 835 submissions per provider.

Additionally, the Provider Adjustment Amount (PLB-04) field is added to the Create EOB and Other EOB Information forms.

'YFB' enables Forward Balance processing on the 835 outbound. This selection adds the fields list above as well as the following:

  • The Enable Balance Forward Processing field on the Contracting Provider 835 Defaults form.
    This field must be set to Yes in order to enable the PLB fields on the Create EOB and Other EOB Information forms. When enabled, the Adjustment Reason Code (PLB-03-01) field will be set to Forwarding Balance.
  • The Sort (Final) selection is enabled in the Options field, on the 835 Health Care Claim Payment/Advice form. 

 Once an EOB is included on an 835 that has been sorted as final it cannot be included in another 835 file, and will not be listed in the Select EOB(s) field. 

'N' removes these fields from the form and disables all PLB segment and Forward Balance processing from the 835.