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