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