Provider Level Adjustment Codes will be found at the top of an ERA > Payment Entry Mode in a blue dashed box. These codes represent funds that are being taken back, carried forward, interest paid, interest reversed, or being used to pay services on the ERA.
Provider Level Balance (PLB) reason codes describe adjustments the payer makes at the provider level, instead of a specific claim or service line. Some examples of provider-level adjustments would be:
|FB||Forward Balance||Used to reflect a balance being moved forward to a future remit or a balance that is brought forward from a prior remit. A negative value represents a balance moving forward to a future payment advice. A positive value represents a balance being applied from a previous payment advice.|
|WO||Overpayment Recovery||Used when a previous overpayment is recouped from the provider of service.|
|72||Authorized Return||Used to report the dollar amount returned by the provider of service for a previous overpayment. Used to report a voided check.|
|IR||Internal Revenue Services Withholding||Used for IRS tax withholding.|
|L6||Interest Owed||Used to report interest paid on claims. The amount of interest paid is reported in the PLB L6 as a negative amount and adds to the check total, which will need to be applied as Interest. A positive value represents an amount of previously paid interest that has now been reversed.|
|CS||Adjustment||Used to report the reissued payment amount for a lost check; or to reduce a PLB FB balance if the payer writes off an amount a provider owes; or to reduce a PLB FB balance when the overpayment amount has been reduced.|
Reference Numbers Used with PLB Codes
- Procentive Claim Number: Often seen when a payer is using takeback credits from a prior ERA. Copy this Procentive claim number > go to Payments module > Open any client > paste the claim number in the Client/Claim field. This will populate the client and DOS associated with the original takeback, allowing you to then locate the original ERA to pull the takeback credits from.
- Check Number: Some payers will enter the check number associated with the original ERA where the takeback had been done and where the credits should be available to use. You can copy this check number and visit the ERA module or the Payments module to search for it specifically if needed.
- Claim Number: These aren't stored in Procentive. You will need to call the payer to determine the client, DOS, and original ERA associated with the claim number provided.
- NEGBAL: This is a generic reference and makes it very challenging to determine where the original funds are coming from. You will need to call the payer directly to have them clarify.
NOTE: More specific examples and definitions can be found here.