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