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