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