Name	Value
CODE	N696
STATUS EFFECTIVE DATE	2013-11-01 00:00:00 STATUS: ACTIVE FEE USE: APPLICABLE
DESCRIPTION EFFECTIVE DATE	DESCRIPTION: Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment. DESCRIPTION: Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.

Name

Value

CODE

N696

STATUS EFFECTIVE DATE

DESCRIPTION EFFECTIVE DATE

DESCRIPTION:

Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.

DESCRIPTION:

Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.

N696 (975) REMITTANCE REMARK (161.93)