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