Interest (L6): Which NPI to put in the PLB01 when there is a Payee NPI in the N1 and one or more Service NPI(s) in the NM1*82? Should the payer send the payee NPI or the service provider(s) NPI in the PLB01?
REFERENCES:
-1.10.2.9: 'Convey the net for all claims..'
-NM1 (TR3 Note): 'provided to facilitate identification of the claim..
-PLB (Sit Rule): 'required when reporting adjustments to the actual payment that are NOT specific to a particular claim or service'
EX1:
N1*PE*PAYEE*xx*NPI A
CLP*xxxxxxxxxx*1*xxx*xxx*xx*xx*CLAIM 1*11*1
NM1*82*2*SERVICE PROV 1*****XX*NPI B
AMT*I*21.00
CLP*xxxxxxxxxx*1*xxx*xxx*xx*xx*CLAIM 2*11*1
NM1*82*2*SERVICE PROV 2 *****XX*NPI C
AMT*I*12.00
PLB*NPI A*20181231*L6*-33
OR
EX2:
N1*PE*PAYEE*xx*NPI A
CLP*xxxxxxxxxx*1*xxx*xxx*xx*xx*CLAIM 1*11*1
NM1*82*2*SERVICE PROV 1*****XX*NPI B
AMT*I*21.00
CLP*xxxxxxxxxx*1*xxx*xxx*xx*xx*CLAIM 2*11*1
NM1*82*2*SERVICE PROV 2 *****XX*NPI C
AMT*I*12.00
PLB*NPI B*20181231*L6*-21
PLB*NPI C*20181231*L6*-12
The PLB – Provider Adjustment segment is “Required when reporting adjustments to the actual payment that are NOT specific to a particular claim or service. If not required by this implementation guide, do not send.” The purpose of the PLB is to make adjustments to provider payments not specific to a particular claim or service. Therefore, the NPI reported in the PLB01 must be the NPI of the provider who was paid in association with the payment(s) being adjusted.