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