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