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