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