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