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