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