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