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