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Basics of Provider Level Balance (PLB) Reason Codes - Palmetto GBA ... prev.

PLB REASON CODE - This field indicates the provider-level adjustment reason code. Provider Adjustment (ADJ) Details Section PLB Reason Codes. Field Description; 50: Net of all late file charges (positive and negative) of all the impacted claims on the remittance advice. Used to identify Late Claim Filing Penalty. AP: Used to reflect accelerated payment amounts or. If billing value codes 15 or 47 and the benefits are exhausted please contact the BCRC to update the records and bill primary. Value Codes 16, 41, and 42 should not be billed conditional. You should bill Medicare primary. Value code 13 and value code 12 or 43 cannot be billed on the same claim.

Code Descriptions. 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: Used to reflect a balance being moved forward to a future remit or a balance that is brought forward from a prior remit..

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Itemized bills can be faxed to 1 (877)-788-2764. 45 No EOB Please resubmit with EOB in order to complete processing of the claim. 46 No occurrence code Please resubmit with corrected Occurrence Code on claim. 47 Correct occurrence span Please resubmit with corrected Occurrence Code Span on claim. EOB Codes- EOB Remark Codes. EOB Codes: Description: 0: This claim/service is pending for program review. 1: Member’s I.d. Number Is Missing Or Incorrect: 2 Number On Claim Does Not Match Number On Prior Authorization Request. 3: A minimum of one detail is required. 4: DME rental beyond the initial 30 day period is not payable without prior authorization. 5:.

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At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) 130 Claim submission fee. 131 Claim specific negotiated discount. 132 Prearranged demonstration project adjustment. 133 The disposition of the claim/service is pending further review. (Use only with Group Code.

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