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