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