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