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