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