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