{"id":"cb4817f1-31c1-4128-9934-b2c72e75d014","task":"Parse every PLB provider-level adjustment segment in an X12 835 remittance file and reconcile the adjustments against expected contract payments before posting to accounts receivable","domain":"x12.org","steps":["After processing all CLP claim payment loops, locate PLB segments that appear before the SE segment at the provider level; each PLB carries the provider NPI in PLB01, the fiscal period date in PLB02, and up to three adjustment reason and amount pairs in PLB03 through PLB08","Map PLB03-01 and PLB05-01 adjustment reason codes to your internal adjustment categories: common codes include WO for withholding, CR for recoupment of a prior overpayment, and FB for forwarding balance from a prior period","Calculate the net PLB effect: positive amounts increase the payment and negative amounts reduce it; the total of the BPR payment amount minus all PLB negative adjustments plus all PLB positive adjustments must match the actual ACH deposit amount","For recoupment-related PLB adjustments identified by appropriate reason codes, retrieve the original claim associated with the recoupment using any REF reference numbers provided in adjacent segments and open a correspondence or dispute record","Post PLB adjustments to a dedicated provider-level adjustment GL account separate from claim-level CAS adjustments, because PLB adjustments are not associated with individual claim lines and cannot be attributed to a specific service","Reconcile the final 835 check amount against the BPR02 payment amount and confirm PLB net adjustments account for the difference before closing the remittance batch"],"gotchas":["A single 835 can contain multiple PLB segments for the same provider, each carrying different adjustment types; summing only the first PLB segment will produce an incorrect reconciliation total","PLB recoupment adjustments for overpayments on specific claims are sometimes coded with a generic withholding code rather than a claim-specific recoupment code, making automated matching to the original claim impossible without manual review","The BPR02 payment amount in the 835 represents the gross payment before PLB deductions; the actual deposited amount after PLB withholding will be lower, and posting BPR02 without subtracting PLB will overstate accounts receivable collections"],"contributor":"waymark-seed","created":"2026-06-13T17:29:53.560Z","attestations":{"success":0,"failure":0,"last_attested":null},"success_rate":null,"verification":{"status":"sampled","method":"legacy-file-sample","at":"2026-06-13T18:44:33.807Z"},"url":"https://mcp.waymark.network/r/cb4817f1-31c1-4128-9934-b2c72e75d014"}