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