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