Before you start
Sometimes the check or EFT amount on an EOB doesn't equal the total of the claims paid on it. The difference is reported at the provider level, not on a claim. These are PLB adjustments.
Common reasons:
Situation | What the payer is doing | Typical PLB type |
Offset / recoupment | Keeping money from this check to pay back an earlier overpayment | WO – Overpayment Recovery |
Forwarding balance | Moving a balance from one remit to another (can be positive or negative) | Forwarding Balance |
Interest | Paying you interest because the claim was paid late | Interest |
Third-party charges | Other provider-level amounts listed on the remit | Match the reason on the EOB |
Before you post: Check the PLB section of the EOB. Each PLB line on the EOB needs its own adjustment in NikoHealth.
Offset vs. take-back: In an offset, the payer keeps money from a new payment. If you know which claim the money is for, also post the take-back on that claim. See Posting Payer Recoupments and Payment Reversals.
How PLBs affect the payment
A negative PLB amount lowers the total payment amount.
A positive PLB amount raises the total payment amount.
When the payment is fully posted, Unapplied = $0 and the status is Applied.
If the claims on the payment are posted but Unapplied is not $0, you are probably missing a PLB.
Add a PLB adjustment to a payment
You can add a PLB to a new payment or to one that is already in the system (for example, an ERA that is missing a PLB).
Go to Billing › Payments. Open the payment, or click the blue + and select Add Payment to start a new one.
On the payment, click the blue + and select Edit Payment Details. Click Adjust.
Fill in the adjustment:
Date: the remit date
Amount: the PLB amount from the EOB. Use a negative number to lower the total payment amount or a positive number to raise it.
Provider Ref Id (optional): the reference from the EOB, such as the patient name or claim control number (see Using the Provider Ref Id)
Adjustment: type part of the name and select the type that matches the EOB (for example, type
WOfor WO – Overpayment Recovery)
If the EOB has more than one PLB, click Add Adjustment for each one.
Click Save, then click Save again on the payment. Check that Unapplied = $0 and the status is Applied.
Scenario A: Forwarding balances
Example: The EOB shows a payment of $47.84 for one invoice, plus two forwarding balances, one positive and one negative.
Create the payer payment (Billing › Payments › blue + › Add Payment):
Method: Other
Total payment amount: the check amount on the EOB (in the video example, $0)
Click Add Invoice and select the invoice.
Post the claim the same way as any payer payment:
Invoice-level Payment: $47.84
Each service line: Payer Allowable, Payment, and adjustments. The system adds CO-45, and you add PR-2 or other codes from the EOB.
Each line must balance: Charge − Payments − Adjustments = 0.
Click Save. The payment doesn't balance yet because the forwarding balances aren't posted. In the video, Unapplied shows −$47.84: the $47.84 applied to the claim, against a $0 total payment.
Click the blue + › Edit Payment Details › Adjust, and add one adjustment for each forwarding balance, using the amount and sign from the EOB.
Click Save. Check that Unapplied = $0 and the status is Applied.
Scenario B: Offset (payer keeps money from this check)
Example: The payer paid new claims on this check but kept back money for an overpayment on an earlier claim.
The PLB steps are the same as in the recoupment walkthrough.
Post the new claims on the payment as usual.
Add a PLB:
Amount: the amount kept back, as a negative number
Adjustment: WO – Overpayment Recovery
Provider Ref Id: the claim control number or other reference from the EOB
If the EOB tells you which claim the money is for, find that invoice (see below) and post the take-back as negative amounts on its service lines. Follow [Posting Payer Recoupments and Payment Reversals], Step 2.
Check that Unapplied = $0 and the status is Applied.
Open the earlier invoice and review its status and bill-to so the balance is followed up.
Scenario C: Interest or a PLB that was missed
Example: A payment is already posted, but you notice the EOB also included interest.
Open the payment in Billing › Payments.
Click the blue + › Edit Payment Details › Adjust.
Enter the remit date, the interest amount, and the Interest adjustment.
Click Save.
The interest is tracked in reporting and helps the payment balance.
Using the Provider Ref Id
Payers don't always give much detail about a PLB. Save whatever the EOB shows so you can trace it later:
Forwarding balance: copy the reference shown on the EOB into Provider Ref Id.
Recoupment for a specific claim: the account number on the remit is often the claim control number NikoHealth sent with the claim. Copy it into Provider Ref Id.
Finding the invoice by claim control number
Open the invoice search and use the Claim Control # field.
Payers sometimes add extra digits to the front. If you get no match, try again without the first digits.
An invoice's claim control number is on its Audit tab.
Troubleshooting
Problem | What to check |
Claims are posted but Unapplied isn't $0 | Look for a PLB on the EOB that isn't posted yet. |
Unapplied went up after I added a PLB | The sign may be wrong. Check whether the EOB lowers (negative) or raises (positive) the payment. |
The EOB has several PLBs | Add a separate adjustment for each one using Add Adjustment. |
I don't know which claim an offset is for | Post the PLB with the reference from the EOB in Provider Ref Id. Search for the invoice by claim control number. |
Reporting
PLB Adjustment report — all provider-level adjustments, including overpayment recoveries, forwarding balances, and interest
Payment Detail report — payments, including negative payments (reversals)
Reduce manual posting
The goal is to receive as many payments electronically (ERA) as possible. If a payer still sends paper EOBs, contact the NikoHealth payer enrollment team to ask whether ERA enrollment is available.