D10 (276) ADJUSTMENT REASON (161.91)
Name
Value
CODE
D10
STATUS EFFECTIVE DATE
2003-06-01 00:00:00
STATUS: ACTIVE
FEE USE: NOT APPLICABLE
2003-10-16 00:00:00
STATUS: INACTIVE
FEE USE: APPLICABLE
DESCRIPTION EFFECTIVE DATE
DESCRIPTION:
Claim/service denied. Completed physician financial relationship form not on file.
DESCRIPTION:
Claim/service denied. Completed physician financial relationship form not on file.
SUSPENSION DESCRIPTION
Claim/service denied. Completed physician financial relationship form not on file.
