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