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