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