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