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