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Recoupments are identified with the plb reason code wo The sum of all claim payments (clp04) minus the sum of all provider level adjustments (in the plb segment) equals the total payment (bpr02) Clarification of the plb reason codes fb and wo are below
A forwarding balance is not a recoupment To view this module, select one of the links below: It is notifying the provider the claim has already paid previously
The claim may have previously paid more, less, or the same.
• the payment amount sent to the irs is reported in the plb segment with an ir adjustment reason code and a positive dollar amount • the claim will be in the same 835 as the plb. The plb is not always associated with a specific claim in the 835 but must be used to balance the transaction Use the reference id to identify the claim.
To locate the overpaid claim(s) on the era associated with the overpayment recovery indicator (wo), isolate the claim payment information (clp) loops and look for the claim details that appear twice on the remittance. Claim adjustment reason codes may be on the remittance advice to explain an adjustment These codes are required when a claim or service line was paid differently than it was billed If there are no adjustments on the claim/line, then there will be no adjustment reason code.
Select the buttons below for more information on the most commonly used 835 adjustment codes
You will learn how it is used and helpful posting tips for each code. This updated module gives you the basics of provider level balance (plb) reason codes and helps you reconcile your medicare remittance advices (ras)
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