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