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.