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Miscellaneous: Claims Adjustments
Claims
Claims Adjustments
Claims
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CHARGES
COB
DATE
DIAGNOSIS
MEDICARE
PLACE
PROCEDURE
PROVIDER
SUBSCRIBER
S
D
S
I
S
O
N
G
A
I
D
F
U
J
S
W
D
U
K
P
M
X
Z
V
B
S
J
S
A
E
B
R
R
K
G
K
S
Y
E
F
J
J
F
E
T
P
B
O
C
G
Y
E
G
N
D
J
L
R
C
P
R
Q
W
M
O
I
M
A
E
D
E
A
I
S
V
W
V
F
C
J
T
F
H
N
B
L
A
O
Q
E
E
R
A
C
I
D
E
M
R
E
K
E
R
U
D
E
C
O
R
P
O
L
X
B
S
T
Q
O
X
P
W
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