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Segment
in
X12 Release 003040

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 Number
String (AN)
Mandatory
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
PLB01 is the provider number assigned by the payer.
02
Date
Date (DT)
Mandatory
6
6
-
Date (YYMMDD).
PLB02 is the last day of the providers fiscal year.
03
Reference Number
String (AN)
Mandatory
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
PLB03 is the adjustment information as defined by payer.
04
Monetary Amount
Decimal number (R)
Mandatory
1
15
-
Monetary amount.
PLB04 is the adjustment amount.
05
Reference Number
String (AN)
Conditional
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
P0506
PLB05 is the adjustment information as defined by payer.
06
Monetary Amount
Decimal number (R)
Conditional
1
15
-
Monetary amount.
PLB06 is the adjustment amount.
07
Reference Number
String (AN)
Conditional
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
P0708
PLB07 is adjustment information as defined by payer.
08
Monetary Amount
Decimal number (R)
Conditional
1
15
-
Monetary amount.
PLB08 is the adjustment amount.
09
Reference Number
String (AN)
Conditional
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
P0910
PLB09 is adjustment information as defined by payer.
10
Monetary Amount
Decimal number (R)
Conditional
1
15
-
Monetary amount.
PLB10 is the adjustment amount.
11
Reference Number
String (AN)
Conditional
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
P1112
PLB11 is adjustment information as defined by payer.
12
Monetary Amount
Decimal number (R)
Conditional
1
15
-
Monetary amount.
PLB12 is the adjustment amount.
13
Reference Number
String (AN)
Conditional
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
P1314
PLB13 is adjustment information as defined by payer.
14
Monetary Amount
Decimal number (R)
Conditional
1
15
-
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.