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Biochem J 188(2):549552 Wang X, Liu R, Zhang W, Zhang X, Liao N, Wang Z, Li W, Qin X, Hai C (2013) Oleanolic acid improves hepatic insulin resistance via antioxidant, hypolipidemic and anti-inflammatory effects

Heres a rough guide that some doctors use, though everyones situation is different: Kidney Function and B12 Dosing Considerations: Above 90 (Normal): Standard B12 doses are usually fine, check levels every 6 months 60-89 (Mild decrease): Might consider slightly lower doses, check every 4 months 30-59 (Moderate decrease): Definitely worth discussing lower doses with your doctor, check every 3 months 15-29 (Severe decrease): High doses probably arent a good idea, monthly monitoring Below 15 (Kidney failure): Avoid high doses entirely, close medical supervision Let me share a story that really opened my eyes to this

Submit it without the fourth character and it draws an automatic edit rejection from every payer, no matter how good the documentation is