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