To provide an improved experience for providers, Harvard Pilgrim is updating the Provider Level Balance (PLB) segment in the 835 remittance advice available via our electronic payment vendor, Payspan, beginning Dec. 16, 2021.
We currently send a Harvard Pilgrim-generated claim number in the PLB03-2 segment, but in order to better assist our provider partners in resolving adjustments in their systems, we will begin sending the provider’s patient control number, which is received on the inbound claim.
On electronic claims, the patient control number is located in the CLM01. It can be found in Box 26 on the paper CMS-1500 professional claim form and in Field 3a on paper institutional UB-04 claims.
An example of how this is currently reported is as follows:
PLB*1211452365*20130524*CS:1234591-180113M24823 (HPHC claim number)*-14.99~
With the update to the PLB segment it will look like the following example:
PLB*1211452365*20130524*CS:1234591- 12345 (patient control number received on claim)*-14.99~
Our Provider Level Balance (PLB) Supplement to the Electronic Remittance Advice 835 Transaction Companion Guide will be updated by Dec. 16 to reflect this change.