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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
M
F
R
M
H
K
I
Z
C
S
C
X
O
P
G
Y
F
I
U
U
I
X
E
E
P
L
V
Y
A
B
D
S
G
R
R
R
Q
A
A
S
A
Q
O
B
U
A
Y
B
O
C
R
O
V
N
Q
D
C
H
A
R
G
E
S
O
G
V
E
I
W
I
A
O
B
T
I
A
V
C
D
B
O
S
W
D
I
A
I
T
O
E
P
X
G
O
I
Z
D
D
X
R
M
G
K
J
T
U
Z
D
C
J
P
R
O
V
I
D
E
R
O
Z
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