Provider Notice issued 02/08/10

Changes to Pharmacy 835 PLB Segment

Effective for payment vouchers created on or after May 1, 2010, the Illinois Department of Healthcare and Family Services (HFS) will be instituting changes to the Electronic Remittance Advice (835) PLB segment. These changes are intended to facilitate the process by which pharmacies match adjustments on remittance advices to the original claims.

Previously, the PLB segment was designed to include the HFS assigned Adjustment Document Control Number (Adjustment DCN), and Service Section (SS) numbers to match the remittance advice adjustments back to the original claim. However, many pharmacies do not carry the original HFS DCN in their accounts receivable systems, and therefore they are unable to electronically match adjustments in the PLB segment to their paid prescriptions. Therefore, HFS has decided to eliminate the Adjustment DCN and SS numbers, and replace them with the Prescription Number and Date of Service.

Please note that this change will only apply to situations where the individual service can be identified (detail adjustments). In the situation where HFS cannot identify an individual service for a recovery, an administrative (mass adjustment) will be generated. In this situation, HFS will substitute all “9” in the Prescription Number and Date of Service fields for identification purposes.

The following page gives examples of the before and after formats (Detail and Mass adjustments). Please provide a copy of this notice to your software vendor as soon as possible.

Questions regarding this notice or access to HIPAA 835 files should be directed to the Bureau of Pharmacy Services at 1-877-782-5565 Option 7.

Theresa A. Eagleson, Administrator

Division of Medical Programs

Important: Please ensure that a copy of this notice is given to either your Information Systems department or your software vendor.

Current (pre 05-01-2010) PLB format

PLB*1234567890*20091231*WO:21C12345987620091152800011501*-3.77

Revised (05-01-2010 and after) PLB format (BOLD numbers indicate changes)

Detail Adjustment

PLB*1234567890*20091231*WO:21C1234598760003774 20090401*-3.77

Please note the space between prescription # and date of service.

Mass Adjustment

PLB*1234567890*20091231*WO:21C1234598769999999999999999*-3.77

Please note that there is no space between bolded data elements.