知行 EDI 规范查询平台™
Segment
X12 EDI Release 00504
PLBProvider 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
Elements
  • PLB01127Reference Identification
    AN
    M必须(Mandatory)
    Min 1 / Max 80

    Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

  • PLB02373Date
    DT
    M必须(Mandatory)
    Min 8 / Max 8

    Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year

  • PLB03C042Adjustment IdentifierM必须(Mandatory)
    426127
    • PLB0301426Adjustment Reason Code
      ID
      M必须(Mandatory)

      Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment

      Codes (612)
    • PLB0302127Reference Identification
      AN
      O可选(Optional)
      Min 1 / Max 80

      Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

  • PLB04782Monetary Amount
    R
    M必须(Mandatory)
    Min 1 / Max 18

    Monetary amount

  • PLB05C042Adjustment IdentifierO可选(Optional)
    426127
    • PLB0501426Adjustment Reason Code
      ID
      M必须(Mandatory)

      Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment

      Codes (612)
    • PLB0502127Reference Identification
      AN
      O可选(Optional)
      Min 1 / Max 80

      Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

  • PLB06782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • PLB07C042Adjustment IdentifierO可选(Optional)
    426127
    • PLB0701426Adjustment Reason Code
      ID
      M必须(Mandatory)

      Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment

      Codes (612)
    • PLB0702127Reference Identification
      AN
      O可选(Optional)
      Min 1 / Max 80

      Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

  • PLB08782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • PLB09C042Adjustment IdentifierO可选(Optional)
    426127
    • PLB0901426Adjustment Reason Code
      ID
      M必须(Mandatory)

      Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment

      Codes (612)
    • PLB0902127Reference Identification
      AN
      O可选(Optional)
      Min 1 / Max 80

      Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

  • PLB10782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • PLB11C042Adjustment IdentifierO可选(Optional)
    426127
    • PLB1101426Adjustment Reason Code
      ID
      M必须(Mandatory)

      Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment

      Codes (612)
    • PLB1102127Reference Identification
      AN
      O可选(Optional)
      Min 1 / Max 80

      Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

  • PLB12782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • PLB13C042Adjustment IdentifierO可选(Optional)
    426127
    • PLB1301426Adjustment Reason Code
      ID
      M必须(Mandatory)

      Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment

      Codes (612)
    • PLB1302127Reference Identification
      AN
      O可选(Optional)
      Min 1 / Max 80

      Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

  • PLB14782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

知行 EDI 规范查询平台™ 2023 - 3.1.18
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