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