When a negative balance occurs, it can be difficult to tell where the offset started — especially if it isn’t tied to a single claim. One of the most handy and reliable ways to reconcile your accounts is to reference the Provider-Level Balance (PLB) segment on your 835 Electronic Remittance Advice (ERA). The PLB can help you understand why a negative balance exists and how it is being applied against current payments.

Utilizing the PLB segment

The PLB segment reflects the prior payment number associated with negative balance activity, which can help you trace offsets back to the original transaction that created the negative balance. A negative balance will be reported in the PLB segment using the code FB, which refers to forwarding balance. The segment will contain the dollar amount and payment number. 

The PLB segment will change over subsequent 835 ERAs as offsets are applied and will reference the previous payment number, helping you track where the negative balance started and how much has been applied with each payment.

  • Example: Your account has a -$5,000 provider-level balance. This week you have $1,000 in payable claims. Your 835 ERA may show a $0 payment, with the $1,000 applied to reduce the negative balance to -$4,000. If, the following week, you have $3,000 in payable claims, the PLB segment will reference the prior payment number and show that the negative balance was further reduced to -$1,000.

To assist you in understanding the PLB segment, we have a dedicated user guide in the EDI section of our provider website, Provider-Level Balance: Supplement to the ERA 835 Transaction Companion Guide. 

Please note that payment numbers beginning with APNOCK will always be reporting a negative balance from retracted claims. Future payments will be offsetting against that negative balance. 

Refund checks may also be referenced in the PLB segment. In the event that you submit a refund check without enough identifying information, it may be returned. That activity can be referenced in the 835’s PLB segment—often using your own check number—so you can match the refund to the remittance record.

Negative balance report offers another option

Our secure transaction portal for Harvard Pilgrim Health Care, HPHConnect, also offers a Negative Balance Report that provides a history of claims retracted or adjusted that create a negative balance, as well as any claims used to offset that balance. 

To access the report, the user must have the Back Office User role (or higher). If needed, your organization can update user roles to enable report access.

Our HPHConnect Negative Balance Report User Guide details how to run this report and offers report examples and explanations.

Paper EOPs

If you receive paper checks, you can find negative balance information in the summary box on the EOP, including which members may be affected and what needs to be reconciled. For a more efficient experience, we recommend using electronic funds transfer (EFT) and electronic claims submission tools.