Knowledge Center

May 20, 2019

Document outlines and explains common complexities of the PLB

WASHINGTON, DC — May 20, 2019 — WEDI, the nation’s leading nonprofit authority on the use of health IT to create efficiencies in healthcare information exchange and a statutory advisor to the U.S. Department of Health and Human Services (HHS), today announced the development of an industry white paper to provide guidance and information on the functionality and usage of the Provider Adjustment Segment (PLB) within the electronic remittance advice (835). Written by the WEDI Remittance Advice and Payment Subworkgroup, the paper explores the different business use cases of the PLB, issues that commonly appear for those use cases, and provides some best practices to remediate challenges that both payers and providers experience.

According to the paper, “The PLB segment has historically been problematic for both payers and providers. Payers often do not provide all the necessary information in the 835 and providers often are not able to correctly interpret the information provided.”

The 23-page document outlines specific business use cases for the PLB and how information should flow from the payer to the provider. Some key takeaways from the white paper’s conclusion include:

• The PLB segment is necessary to convey specific information related to adjustments to the total provider payment amount but is often used incorrectly or misunderstood.
• The payer’s technical team and the business teams must work together to identify the data to be reported and how to include the data in the 835 to clearly identify to the provider how to use the information.
• It is critical that the payer pay close attention to instructions in the X12 835 TR3 when implementing the PLB in order to correctly convey the information to the provider.
• It is important that the provider’s practice management system manage the PLB segments correctly in order to get the information posted correctly without unnecessary manual intervention by the provider.

For more information on WEDI’s industry efforts surrounding Provider Adjustments, please visit the WEDI Remittance Advice and Payment Subworkgroup page.

About WEDI
WEDI is the leading authority on the use of health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency, and reduce costs of our nation’s healthcare system. WEDI was formed in 1991 by the Secretary of Health and Human Services and was designated in the 1996 HIPAA legislation as an advisor to HHS. WEDI’s membership includes a broad coalition of organizations, including: hospitals, providers, health plans, vendors, government agencies, consumers, not-for-profit organizations, and standards development organizations. To learn more, visit www.wedi.org and connect with us on Twitter and LinkedIn.