EDI
API DocsTerminal

PLB Provider Level Adjustment

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

Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
127
Reference Identification
String (AN)
Mandatory
1
80
1
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
PLB01 is the provider number assigned by the payer.
02
Date
Date (DT)
Mandatory
8
8
1
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year
PLB02 is the last day of the provider's fiscal year.
03
Adjustment Identifier
Composite (composite)
Mandatory
1
01
Industry Code
String (AN)
Mandatory
1
30
-
Code indicating a code from a specific industry code list
C042-01 identifies the reason for the credit or debit adjustment. See Code Source 967.
02
Reference Identification
String (AN)
Optional
1
80
-
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
04
Monetary Amount
Decimal number (R)
Mandatory
1
18
1
Monetary amount
PLB04 is the adjustment amount.
05
Adjustment Identifier
Composite (composite)
Conditional
1
01
Industry Code
String (AN)
Mandatory
1
30
-
Code indicating a code from a specific industry code list
C042-01 identifies the reason for the credit or debit adjustment. See Code Source 967.
02
Reference Identification
String (AN)
Optional
1
80
-
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
06
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
PLB06 is the adjustment amount.
07
Adjustment Identifier
Composite (composite)
Conditional
1
01
Industry Code
String (AN)
Mandatory
1
30
-
Code indicating a code from a specific industry code list
C042-01 identifies the reason for the credit or debit adjustment. See Code Source 967.
02
Reference Identification
String (AN)
Optional
1
80
-
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
08
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
PLB08 is the adjustment amount.
09
Adjustment Identifier
Composite (composite)
Conditional
1
01
Industry Code
String (AN)
Mandatory
1
30
-
Code indicating a code from a specific industry code list
C042-01 identifies the reason for the credit or debit adjustment. See Code Source 967.
02
Reference Identification
String (AN)
Optional
1
80
-
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
10
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
PLB10 is the adjustment amount.
11
Adjustment Identifier
Composite (composite)
Conditional
1
01
Industry Code
String (AN)
Mandatory
1
30
-
Code indicating a code from a specific industry code list
C042-01 identifies the reason for the credit or debit adjustment. See Code Source 967.
02
Reference Identification
String (AN)
Optional
1
80
-
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
12
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
PLB12 is the adjustment amount.
13
Adjustment Identifier
Composite (composite)
Conditional
1
01
Industry Code
String (AN)
Mandatory
1
30
-
Code indicating a code from a specific industry code list
C042-01 identifies the reason for the credit or debit adjustment. See Code Source 967.
02
Reference Identification
String (AN)
Optional
1
80
-
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
14
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
PLB14 is the adjustment amount.

Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.

Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.