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