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