What does J1 mean on a Medicare remit?
J1. Non-reimbursable – Used to offset claim or service level data that reflects what could be paid if not for demonstration programs or other limitation that prevents issuance of payment. For example, this is used to zero balance provider payment for Centers of Excellence and Medicare Advantage RA s.
What is PLB adjustment?
The PLB segment is used to transmit information about Provider-Level Adjustments – that is, payments and debts that are not specific to a particular claim or service. PLBs can either increase or decrease a payment, but will never be zero-dollar.
What is FCN on Medicare EOB?
Financial Control Number (FCN): The adjusted claim internal control number (ICN). This number will match the invoice number listed on the attachment of the demand letter. Beneficiary ID number associated with the claim.
What is a Medicare affiliated withholding?
If the provider does not refund the overpayment by the due date listed in the demand letter, Medicare withholds all payments from the provider until the provider pays the debt in full. Medicare also has the authority to recoup overpayments from affiliated providers.
What does offset for affiliated providers mean?
Offset causes withholding of overpayment amounts on future Medicare payments. This is done in one of two ways: Contractor initiated when the money is not returned within the appropriate time frame after the initial notice of overpayment (see below) Provider requests immediate recoupment. Type of Receivable.
What is total PLB amount?
The sum of all claim payments (CLP04) minus the sum of all provider level adjustments (in the PLB segment) equals the total payment (BPR02). The information in the PLB segment must be taken into consideration for auto-posting of payments to your patient accounts.
What is PLB reason code CS?
Overpayment Reversal Amount returned to the provider when an overpayment has been recovered by minus debit and also received from provider by a refund check. • PLB Adjustment Code: CS. • PLB Adjustment Identifier: Aetna Claim ID – Patient Acct # – Earliest Claim Service Date. • PLB Adjustment Amount: Negative amount.
What is an E3 withholding?
E3. Withholding; Used to reflect a withholding of a set dollar amount or a percentage of a capitation. payment, to be paid later, usually as a result of meeting Performance requirements.
What are three figures that are commonly depicted on an EOB?
the payee, the payer and the patient. the service performed—the date of the service, the description and/or insurer’s code for the service, the name of the person or place that provided the service, and the name of the patient.
What is adjustment code 72?
72. Provider refund amount. This adjustment acknowledges a refund received from a provider for previous overpayment.
What is a Medicare offset?
Offset causes withholding of overpayment amounts on future Medicare payments. This is done in one of two ways: Contractor initiated when the money is not returned within the appropriate time frame after the initial notice of overpayment (see below) Provider requests immediate recoupment.
What does wo mean on an EOB?
Overpayment Recovery (WO) Used when a previous overpayment is recouped from the provider of service. • Used when a reversal and corrected claim are not reported in the same transaction. WO prevents the prior claim payment from being deducted from the transaction.
What is wo amount?
WO – Withholding – Used to recover previous overpayments. A reference number (the original ICN) is applied for tracking purposes. The WO amount is subtracted from the check amount.
What is L3 penalty?
L3. Provider Penalty – indicates an amount withheld from payment based on an established penalty. L6. Interest owed: – If the net interest is added to the “TOTAL PD” amount, then the offset detail will be a negative number. If it is subtracted from the “TOTAL PD” amount, then the offset detail will be a positive number …