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