My question is in regards to the PLB Reference Number. According to the guidelines on page 37-38, it sounds like the PLB Reference Number has to match on the original FB and the offsetting FB. Is that correct? I have a payer that is sending different PLB Reference Numbers. The original FB contains the original claim number that has been reprocessed and is moving the balance forward. The offsetting FB contains the new reprocessed claim number instead of the original so the provider is unable to track these in our system.
This is addressed in section 1.10.2.12 Balance Forward Processing of guide 005010X221A1. When reporting a forward balance the Adjustment Identifier (in PLB03-2, PLB05-2, etc.) is the same for the original and offsetting transactions. The Adjustment Identifier is also the same number as the TRN02 trace number in the original transaction. The forward balance amount is not specific to a single claim. For more information on forward balancing see RFIs 1114 and 2051