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