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