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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
V
S
A
Q
I
P
E
H
V
I
B
U
K
I
T
X
M
C
K
D
H
W
V
B
R
S
K
B
A
R
J
N
E
S
U
S
E
O
U
L
G
C
E
N
R
E
W
C
D
N
P
Q
R
I
O
K
A
G
F
R
I
G
W
X
J
F
H
E
C
R
W
I
V
A
I
E
B
Q
U
T
I
A
U
B
O
I
I
C
Y
F
T
A
D
H
A
E
R
D
T
C
E
R
U
D
E
C
O
R
P
A
Z
O
R
X
Y
J
M
V
E
H
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