---
title: "Recoupments on ERA - PLB Segment"
slug: "recoupments-on-era-plb-segment"
updated: 2025-04-09T14:45:57Z
published: 2025-04-09T14:45:57Z
canonical: "docs.claim.md/recoupments-on-era-plb-segment"
---

> ## Documentation Index
> Fetch the complete documentation index at: https://docs.claim.md/llms.txt
> Use this file to discover all available pages before exploring further.

# Recoupments on ERA - PLB Segment

## Overview

In medical billing, a **recoupment** is the process by which a payer reclaims previously issued funds from a healthcare provider. This can occur for several reasons, not just overpayments. Recoupments are typically documented on the ERA (Electronic Remittance Advice) within the **PLB (Provider-Level Balance)** segment (usually located at the bottom of the ERA form) and are applied at the provider level rather than to a specific claim.

Recoupments may include, but are not limited to:

- **Overpayments:** Funds were mistakenly paid in excess of the correct amount.
- **Duplicate Payments:** A claim or service was reimbursed more than once.
- **Coordination of Benefits (COB) Adjustments:** Another payer was responsible for all or part of the payment.
- **Retractions Due to Eligibility Errors:** Services were rendered to an ineligible patient.
- **Policy Retro-Termination:** The patient’s coverage was retroactively canceled, invalidating payment.

When a provider does not voluntarily return the identified funds, the payer may apply the recouped amount as an offset to future payments. This adjustment is reflected at the bottom of the ERA in the PLB segment.

For example, the PLB on an ERA might display a message like:

```
  PROVIDER ADJ DETAILS: PLB REASON CODE FCN/OTHER IDENTIFIER HIC AMOUNT
  Overpayment Recovery (WO) XXXXXXXXXXXXXXXXXXXXXXX102.45
```

**Note:** Although the PLB segment contains the adjustment, these amounts are usually tied to a specific claim. The payer may include a claim reference such as an **ICN (Internal Control Number)** or account number to indicate which payment is being recouped. Unfortunately, not all payers include sufficient information for providers to easily identify the original claim. In such cases, **providers should reach out to the payer for clarification**.

## Where to Find PLB Segment Recoupments

Recoupments are not displayed in the standard claim history. Instead, they appear at the end of the ERA file in the PLB segment. The PLB segment is part of the ANSI 835 file format.

**Segment Info:**

- **Loop:** 835
- **Segment:** PLB

## Locating Recoupments

To identify a recoupment:

1. Open the ERA file in the [View ERA](/v1/docs/view-era) page.  
![](https://cdn.document360.io/367e6528-88da-4443-9da1-fcdd7e6d4d49/Images/Documentation/image-1742580491523.png)
2. Scroll to the bottom to locate the **PLB segmen**t.
3. Look for adjustment reason codes such as **WO – Overpayment Recovery**.

💡**Helpful Tip:**  
If you're having trouble locating a recoupment, try searching the ERA file for keywords like **“PLB”** or reason codes such as **WO** (Overpayment Recovery). These adjustments are typically listed *after the last processed claim* in the ERA file.

## Representation of PLB Data in XML and JSON Formats

In **XML**, PLB data is typically returned as structured elements under the relevant loop, preserving the adjustment reason codes, amounts, and reference identifiers.

In **JSON**, the same information is returned as key-value pairs within the appropriate object hierarchy, maintaining consistency with the structure and semantics of the original EDI format.

![](https://lh7-rt.googleusercontent.com/docsz/AD_4nXdS-aRV85UNmK2B9YeRrtWwgIZX59H8dT3MbtxhPA1RqH4u32-Vd1bQC9an_I7HrpwoH3L0udWE-rEDmsLJpamZrUz1hMxyt4z-VKllQay5mMifwzm9F6MP_SVvaDoac0-xn4Ge?key=oJkFzkcbsLXR8bbVNFw1cVZn)