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