PLB Provider Level Adjustment

Batch

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

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	127	Reference Identification	Mandatory	Alphanumeric	1/30	1
2	373	Date	Mandatory	Date	8/8	1
C042Adjustment IdentifierMandatory 1
4	782	Monetary Amount	Mandatory	Decimal	1/18	1
C042Adjustment IdentifierRel 1
6	782	Monetary Amount	Rel	Decimal	1/18	1
C042Adjustment IdentifierRel 1
8	782	Monetary Amount	Rel	Decimal	1/18	1
C042Adjustment IdentifierRel 1
10	782	Monetary Amount	Rel	Decimal	1/18	1
C042Adjustment IdentifierRel 1
12	782	Monetary Amount	Rel	Decimal	1/18	1
C042Adjustment IdentifierRel 1
14	782	Monetary Amount	Rel	Decimal	1/18	1

Element Details

ID127

NameReference Identification

LengthMin 1 / Max 30

Position1

RequirementMandatory

EDI Dictionary

PLB Provider Level Adjustment

Elements

Element Details