Adjustment Report
Total Adjustments
$67,900
Contractual
$42,100
62%
Write-offs
$8,400
12%
VSP/EyeMed Lab Fee Chargebacks
$12,800
19%
Lab fee chargebacks withheld from payments — review for reconciliation accuracy.
Other
$4,600
7%
| Practice | Entity | Adj Date | DOS | Claim # | CPT | Adj Reason | Amount |
|---|---|---|---|---|---|---|---|
| VEO | VEO California PC | 01/15/26 | 12/02/25 | CLM-20187 | V2020 | Contractual - VSP | ($45.00) |
| AEC | AEC Idaho LLC | 01/12/26 | 11/15/25 | CLM-10042 | 92004 | Contractual - EyeMed | ($72.00) |
| LAEC | LAEC California PC | 01/18/26 | 12/08/25 | CLM-30287 | V2799 | VSP Lab Fee Chargeback | ($128.00) |
| ECH | ECH Hawaii LLC | 01/20/26 | 11/28/25 | CLM-40102 | 92014 | Write-off | ($250.00) |
| SVEP | SVEP California PC | 01/14/26 | 12/05/25 | CLM-50145 | V2781 | Contractual - Aetna | ($68.00) |
| EKO | EKO New Jersey PC | 01/16/26 | 11/12/25 | CLM-60045 | 92004 | Contractual - Cigna | ($48.00) |
| AEC | AEC Idaho LLC | 01/22/26 | 12/18/25 | CLM-10122 | 92014 | Contractual - Medicare | ($59.00) |
| VEO | VEO California PC | 01/19/26 | 11/18/25 | CLM-20412 | V2020 | EyeMed Lab Fee Chargeback | ($98.00) |
| LAEC | LAEC California PC | 01/24/26 | 12/15/25 | CLM-30198 | V2783 | Contractual - VSP | ($80.00) |
| ECH | ECH Hawaii LLC | 01/26/26 | 10/28/25 | CLM-40156 | 92014 | Write-off | ($180.00) |
| SVEP | SVEP California PC | 01/25/26 | 12/12/25 | CLM-50278 | 92014 | Contractual - United | ($70.00) |
| EKO | EKO New Jersey PC | 01/28/26 | 11/25/25 | CLM-60198 | 92004 | Contractual - EyeMed | ($49.00) |
| AEC | AEC Idaho LLC | 01/28/26 | 12/22/25 | CLM-10234 | V2020 | VSP Lab Fee Chargeback | ($112.00) |
| VEO | VEO California PC | 01/30/26 | 11/05/25 | CLM-20234 | V2781 | Contractual - EyeMed | ($55.00) |
| LAEC | LAEC California PC | 01/30/26 | 12/20/25 | CLM-30478 | 92014 | Contractual - Medicare | ($64.00) |