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