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