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