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Miscellaneous: Claims Adjustments
Claims
Claims Adjustments
Claims
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CHARGES
COB
DATE
DIAGNOSIS
MEDICARE
PLACE
PROCEDURE
PROVIDER
SUBSCRIBER
M
P
L
A
C
E
S
N
L
D
R
Y
R
R
P
T
R
Z
Q
Q
I
J
C
O
E
O
G
H
I
U
Q
A
D
M
C
O
B
V
T
N
W
P
G
E
M
E
H
H
I
I
B
O
B
N
S
S
D
D
A
J
R
D
O
G
O
V
K
U
A
I
R
L
C
E
I
S
O
N
R
P
T
C
G
Z
S
R
I
Z
F
E
H
P
E
A
E
A
B
S
X
A
A
X
X
W
E
R
S
T
U
B
G
G
V
K
E
L
Z
E
P
O
S
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