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