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